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A case of extrahepatic bile duct cancer with distant metastases showing pathological complete response to treatment combining gemcitabine and cisplatin

  • Kai AdachiEmail author
  • Kosuke Okuwaki
  • Ryo Nishiyama
  • Mitsuhiro Kida
  • Hiroshi Imaizumi
  • Tomohisa Iwai
  • Hiroshi Yamauchi
  • Toru Kaneko
  • Rikiya Hasegawa
  • Eiji Miyata
  • Yusuke Kumamoto
  • Wasaburo Koizumi
Case Report
  • 29 Downloads

Abstract

The patient was a 69-year-old female with a chief complaint of yellow staining of her urine. A detailed physical examination and laboratory tests were carried out, and as a result, her condition was diagnosed as unresectable advanced extrahepatic cholangiocarcinoma with liver metastases. Chemotherapy using gemcitabine + cisplatin was initiated, and computed tomography after six cycles revealed that the liver metastases had disappeared, and that a partial response was achieved in the primary tumor. After tan cycles, a pylorus-preserving pancreaticoduodenectomy was performed as conversion surgery, and as a result, a pathological complete response was achieved in the primary tumor. After the primary lesion was resected, we were able to start an adjuvant chemotherapy immediately. Approximately 19 months have passed since the surgery, and the patient is currently alive and recurrence-free. If an improvement of the outcomes of chemotherapy in unresectable advanced biliary tract carcinomas is achieved in the future, there could be an increase in the number of treatment-responsive cases like the one reported in this study. Accumulating a large number of cases successfully treated by conversion surgery, and conducting a detailed analysis of the postoperative course, may help design adequate treatment strategies.

Keywords

Biliary tract cancer Chemotherapy Conversion surgery Pathological complete response 

Notes

Compliance with ethical standards

Conflict of interest

The authors state that they have no conflict of interest.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments.

Informed consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

References

  1. 1.
    Miyasaka S, Ishihara S, Horiguchi A, et al. Biliary tract cancer treatment: 5584 results from the Biliary Tract Cancer Registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg. 2009;16:1–7.CrossRefGoogle Scholar
  2. 2.
    Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.CrossRefGoogle Scholar
  3. 3.
    Rho YS, Barrera I, Metrakos P, et al. Complete resolution of metastatic gallbladder cancer after standard gemcitabine-cisplatin combination therapy. Cureus. 2015;17:e415.Google Scholar
  4. 4.
    Kato A, Shimizu H, Ohtsuka M, et al. Downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer patients treated with gemcitabine plus cisplatin combination therapy followed by radical surgery. Ann Surg Oncol. 2015;22(Suppl 3):S1093–9.CrossRefGoogle Scholar
  5. 5.
    Sharma A, Mohanti B, Raina V, et al. A phase II study of gemcitabine and oxaliplatin (Oxigem) in unresectable gall bladder cancer. Cancer Chemother Pharmacol. 2010;65:497–502.CrossRefGoogle Scholar
  6. 6.
    Moussata D, Bessayah A, Chauvenet M, et al. A pathologic complete response in the surgical specimen after systemic chemotherapy for a gallbladder carcinoma. Cancer Res. 2012;5:106–8.Google Scholar
  7. 7.
    Lim JH, Ryu JK, Choi YJ, et al. A case of common bile duct cancer that completely responded to combination chemotherapy of gemcitabine and TS-1. Gut Liver. 2013;7:371–6.CrossRefGoogle Scholar
  8. 8.
    Yoshida R, Matsuda T, Watanabe T, et al. A case of gallbladder cancer which completely responded to gemcitabine. Gan To Kagaku Ryoho. 2010;37:1771–3.Google Scholar
  9. 9.
    Evans DB, Rich TA, Byrd DR, et al. Preoperative chemoradiation and pancreatico-duodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9.CrossRefGoogle Scholar
  10. 10.
    Okusaka T, Nakachi K, Fukutomi A, et al. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer. A comparative multicenter study in Japan. Br J Cancer. 2010;103:469–74.CrossRefGoogle Scholar
  11. 11.
    Morizane C, Okusaka T, Mizusawa J, et al. Randomized phase II study of gemcitabine plus S-1 versus S-1 in advanced biliary tract cancer: a Japan Clinical Oncology Group trial (JCOG 0805). Cancer Sci. 2013;104:1211–6.CrossRefGoogle Scholar
  12. 12.
    Mizusawa J, Morizane C, Okusaka T, et al. Randomized phase III study of gemcitabine plus S-1 versus gemcitabine plus cisplatin in advanced biliary tract cancer: Japan Clinical Oncology Group Study (JCOG1113, FUGA-BT). Jpn J Clin Oncol. 2016;46:385–8.CrossRefGoogle Scholar
  13. 13.
    Lee J, Park SH, Chang HM, et al. Gemcitabine and oxaliplatin with or without erlotinib in advanced biliary-tract cancer: a multicentre, open-label, randomized, phase 3 study. Lancet Oncol. 2012;13:181–8.CrossRefGoogle Scholar
  14. 14.
    Arai Y, Totoki Y, Hosoda F, et al. Treatment with the fibroblast growth factor receptor (FGFR) kinase inhibitors BGJ398 and PD173074 effectively suppressed transformation. Hepatology. 2014;59:1427–34.CrossRefGoogle Scholar
  15. 15.
    Sia D, Losic B, Moeini A, et al. Massive parallel sequencing uncovers actionable FGFR2-PPHLN1 fusion and ARAF mutations in intrahepatic cholangiocarcinoma. Nat Commun. 2015;6:6087.CrossRefGoogle Scholar
  16. 16.
    Arai Y, Totoki Y, Hosoda F, et al. Fibroblast growth factor receptor 2 tyrosine kinase fusions define a unique molecular subtype of cholangiocarcinoma. Hepatology. 2014;59:1427–34.CrossRefGoogle Scholar
  17. 17.
    Wu YM, Su F, Kalyana-Sundaram S, et al. Identification of targetable FGFR gene fusions in diverse cancers. Cancer Discov. 2013;3:636–47.CrossRefGoogle Scholar
  18. 18.
    Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.CrossRefGoogle Scholar
  19. 19.
    Okusaka T, Ikeda M, Fukutomi A, et al. Phase II study of FOLFIRINOX for chemotherapy-naïve Japanese patients with metastatic pancreatic cancer. Cancer Sci. 2014;105:1321–6.CrossRefGoogle Scholar
  20. 20.
    Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.CrossRefGoogle Scholar
  21. 21.
    Von Hoff DD, Ramanathan RK, Borad MJ, et al. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol. 2011;29:4548–54.CrossRefGoogle Scholar
  22. 22.
    Ueno H, Ikeda M, Ueno M, et al. Phase I/II study of nab-paclitaxel plus gemcitabine for chemotherapy-naive Japanese patients with metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2016;77:595–603.CrossRefGoogle Scholar
  23. 23.
    Park JK, Paik WH, Ryu JK, et al. Clinical significance and revisiting the meaning of CA 19-9 blood level before and after the treatment of pancreatic ductal adenocarcinoma: analysis of 1446 patients from the pancreatic cancer cohort in a single institution. PLoS One. 2013;8:e78977.CrossRefGoogle Scholar
  24. 24.
    Choi M, Heibrun LK, Venkatramanamoorthy R, et al. Using 18F-fluorodeoxyglucose positron emission tomography to monitor clinical outcomes in patients treated with neoadjuvant chemoradiotherapy for locally advanced pancreatic cancer. Am J Clin Oncol. 2010;33:257–61.Google Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Kai Adachi
    • 1
    Email author
  • Kosuke Okuwaki
    • 1
  • Ryo Nishiyama
    • 2
  • Mitsuhiro Kida
    • 1
  • Hiroshi Imaizumi
    • 1
  • Tomohisa Iwai
    • 1
  • Hiroshi Yamauchi
    • 1
  • Toru Kaneko
    • 1
  • Rikiya Hasegawa
    • 1
  • Eiji Miyata
    • 1
  • Yusuke Kumamoto
    • 2
  • Wasaburo Koizumi
    • 1
  1. 1.Department of GastroenterologyKitasato University School of MedicineSagamiharaJapan
  2. 2.Department of SurgeryKitasato University School of MedicineSagamiharaJapan

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