杜伐单抗联合吉西他滨和顺铂治疗伴有Lynch综合征相关错配修复缺陷的肝内胆管癌后病理完全缓解

IF 0.8 Q4 GASTROENTEROLOGY & HEPATOLOGY
Clinical Journal of Gastroenterology Pub Date : 2025-06-01 Epub Date: 2025-04-10 DOI:10.1007/s12328-025-02122-1
Koshiro Fukuda, Akiyoshi Kasuga, Yasuyuki Shigematsu, Kenichiro Kato, Hiromichi Ito, Arisa Ueki, Takeshi Okamoto, Masato Ozaka, Yu Takahashi, Naoki Sasahira
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引用次数: 0

摘要

64岁男性,有直肠癌和结肠癌手术史,因CT检查发现肝脏肿块而被转诊。他被诊断为不可切除的肝内胆管癌(ICC),伴有肝门周围和主动脉旁淋巴结转移。吉西他滨与顺铂联合治疗(GC) 4个疗程后,随访CT示原发肿瘤轻微增大,碳水化合物抗原(CA)轻微升高19-9。基于强烈的癌症家族史,在GC治疗期间进行基因检测。发现了MLH1的种系致病变异,导致Lynch综合征(LS)的错配修复缺陷(dMMR: MLH1/PMS2缺失)的诊断。Durvalumab在日本获得监管部门批准后加入GC治疗。仅在GC和durvalumab治疗两个周期后,观察到肿瘤大小和CA19-9的显著减少。观察到持续改善,并进行了转换手术,包括肝切除术,部分下腔静脉切除术,门周和主动脉旁淋巴结清扫。所有切除标本均未发现恶性细胞,符合病理完全缓解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pathological complete response following addition of durvalumab to gemcitabine and cisplatin therapy for intrahepatic cholangiocarcinoma with Lynch syndrome-associated mismatch repair deficiency.

A 64-year-old man with a history of surgery for rectal cancer and colon cancer was referred for a hepatic mass identified on computed tomography (CT). He was diagnosed with unresectable intrahepatic cholangiocarcinoma (ICC) with perihilar and para-aortic lymph node metastases. After 4 cycles of gemcitabine and cisplatin combination therapy (GC therapy), follow-up CT showed slight enlargement of the primary tumor and a slight increase in carbohydrate antigen (CA) 19-9. Genetic testing was performed during GC therapy based on the strong family history of cancer. Germline pathogenic variant in MLH1 was identified, leading to the diagnosis of Lynch syndrome (LS) with mismatch repair deficiency (dMMR: loss of MLH1/PMS2). Durvalumab was added to GC therapy following regulatory approval in Japan. A significant reduction in tumor size and CA19-9 was observed after only two cycles of GC and durvalumab therapy. Continuous improvement was observed, and conversion surgery involving liver resection, partial inferior vena cava resection, and perihilar and para-aortic lymph nodes dissection was performed with curative intent. No malignant cells were found in any of the resected specimens, consistent with pathological complete response.

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来源期刊
Clinical Journal of Gastroenterology
Clinical Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.00
自引率
0.00%
发文量
182
期刊介绍: The journal publishes Case Reports and Clinical Reviews on all aspects of the digestive tract, liver, biliary tract, and pancreas. Critical Case Reports that show originality or have educational implications for diagnosis and treatment are especially encouraged for submission. Personal reviews of clinical gastroenterology are also welcomed. The journal aims for quick publication of such critical Case Reports and Clinical Reviews.
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