PMID- 32508620
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 1662-6575 (Print)
IS  - 1662-6575 (Electronic)
IS  - 1662-6575 (Linking)
VI  - 13
IP  - 1
DP  - 2020 Jan-Apr
TI  - Checkpoint Inhibition Causing Complete Remission of Metastatic Combined 
      Hepatocellular-Cholangiocarcinoma after Hepatic Resection.
PG  - 478-484
LID - 10.1159/000507320 [doi]
AB  - Combined hepatocellular-cholangiocarcinoma (CHC) is a rare type of primary liver 
      cancer, speculated to arise from hepatic progenitor cells, and with a worse 
      prognosis than hepatocellular carcinoma (HCC). Serum alpha-fetoprotein (AFP) 
      levels may be one prognostic factor. It has been suggested that checkpoint 
      inhibition might be useful in the treatment of HCC where there is an increased 
      expression of PD-1 and PD-L1 in the microenvironment. Its effect on CHC is 
      unknown. We report a case with a large CHC, which was radically resected, but the 
      53-year-old female patient subsequently developed pulmonary metastases. Histology 
      demonstrated low-differentiated CHC without microsatellite instability. Treatment 
      with sorafenib was started but was stopped due to angioedema. Under subsequent 
      gemcitabine/cisplatin treatment, the metastatic disease progressed with rising 
      AFP levels. A third-line treatment with pembrolizumab was then started, 2 mg/kg 
      b.w. i.v. every third week for 6 months. This resulted in a radiologically 
      complete remission of the pulmonary metastases and AFP levels were normalized 
      (<10 mug/L) from a level of 1,790 mug/L before treatment. The patient developed 
      immune-related adverse events (AEs) including diarrhea and hepatitis. These AEs 
      were successfully treated with prednisolone and mycophenolate mofetil, and they 
      were eventually resolved. There are no signs of cancer recurrence neither in the 
      liver nor in the lungs at 33 months after the start of the checkpoint inhibition 
      treatment, and the patient is doing well. Further study is urgently needed on the 
      role of checkpoint inhibition therapy in liver cancer.
CI  - Copyright (c) 2020 by S. Karger AG, Basel.
FAU - Rizell, Magnus
AU  - Rizell M
AD  - Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Aberg, Fredrik
AU  - Aberg F
AD  - Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Perman, Mats
AU  - Perman M
AD  - Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Ny, Lars
AU  - Ny L
AD  - Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Sten, Liselotte
AU  - Sten L
AD  - Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Hashimi, Farida
AU  - Hashimi F
AD  - Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Svanvik, Joar
AU  - Svanvik J
AD  - Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Lindner, Per
AU  - Lindner P
AD  - Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
LA  - eng
PT  - Case Reports
DEP - 20200430
PL  - Switzerland
TA  - Case Rep Oncol
JT  - Case reports in oncology
JID - 101517601
PMC - PMC7250374
OTO - NOTNLM
OT  - Checkpoint inhibition
OT  - Combined hepatocellular-cholangiocarcinoma
OT  - Immune-related hepatitis
OT  - Sorafenib
COIS- The authors have no conflicts of interest to declare.
EDAT- 2020/06/09 06:00
MHDA- 2020/06/09 06:01
PMCR- 2020/04/30
CRDT- 2020/06/09 06:00
PHST- 2020/03/16 00:00 [received]
PHST- 2020/03/17 00:00 [accepted]
PHST- 2020/06/09 06:00 [entrez]
PHST- 2020/06/09 06:00 [pubmed]
PHST- 2020/06/09 06:01 [medline]
PHST- 2020/04/30 00:00 [pmc-release]
AID - cro-0013-0478 [pii]
AID - 10.1159/000507320 [doi]
PST - epublish
SO  - Case Rep Oncol. 2020 Apr 30;13(1):478-484. doi: 10.1159/000507320. eCollection 
      2020 Jan-Apr.