Case Report: Camrelizumab combined with gemcitabine and oxaliplatin in the treatment of advanced intrahepatic cholangiocarcinoma: a case report and literature review

Abstract

Intrahepatic cholangiocarcinoma (ICC) is one of the most common invasive malignant tumors, with a 5-year survival rate of less than 5%. Currently, radical surgical resection is the preferred treatment for ICC. However, most patients are only diagnosed at an advanced stage and are therefore not eligible for surgery. Herein, we present a case of advanced ICC in which radical surgery was not possible due to tumor invasion of the second porta hepatis and right hepatic artery. Six treatment cycles with a gemcitabine and oxaliplatin (GEMOX) regimen combined with camrelizumab immunotherapy achieved a partial response and successful tumor conversion, as tumor invasion of the second porta hepatis and right hepatic artery was no longer evident. The patient subsequently underwent successful radical surgical resection, including hepatectomy, caudate lobe resection, and cholecystectomy combined with lymph node dissection. Cases of patients with advanced ICC undergoing surgical resection after combined immunotherapy and chemotherapy are rare. The GEMOX regimen combined with camrelizumab demonstrated favorable antitumor efficacy and safety, suggesting that it might be a potential feasible and safe conversion therapy strategy for patients with advanced ICC.

The fibrosis-4 index is a prognostic factor for cholangiocarcinoma patients who received immunotherapy

“…Studies on the application of pembrolizumab for incurable cholangiocarcinoma in Phase I b and II trials have found that regardless of PD-L1 expression, it can effectively control 6%-13% of advanced bile duct cancers, with manageable toxicity (6).A real-world study based on Phase III clinical trial TOPAZ-1, incorporating durvalumab into the first-line chemotherapy regimen for cholangiocarcinoma, demonstrated a 20% reduction in the risk of death (HR=0.80, 95% CI: 0.66-0.97, P=0.021), confirming the efficacy and safety of durvalumab for cholangiocarcinoma patients (7). Subsequently, more studies and case reports on the application of other immune checkpoint inhibitors in cholangiocarcinoma have emerged, further bolstering the case for immunotherapy in cholangiocarcinoma (8)(9)(10)(11).Currently, the combination of durvalumab with gemcitabine and cisplatin is an option for first-line treatment of locally advanced or metastatic cholangiocarcinoma. However, further research is needed to verify the application of immune checkpoint inhibitors in cholangiocarcinoma and to identify prognostic risk factors for patients receiving immunotherapy.…”