Cholangiocarcinoma: A clinical case of long-lasting response to immunochemotherapy

Cholangiocellular carcinoma is a heterogeneous group of malignant neoplasms of the biliary tract. It accounts for approximately 3% of all gastrointestinal tumors and is the second most common primary liver tumor after hepatocellular carcinoma. Surgery is the only cure. Surgical treatments are among the most complex in hepatopancreatobiliary surgery. Standard first-line therapy with gemcitabine-based chemotherapy has demonstrated a modest improvement in survival in patients with advanced cholangiocellular carcinoma. Despite its role as the cornerstone of first-line therapy, chemotherapy produces suboptimal response rates, and overall survival highlights the urgent need for improved therapeutic strategies. The TOPAZ-1 trial, which included an immuno-oncology agent, demonstrated an improvement in overall survival. In the case described above, the patient first presented for this condition in 2022. After diagnosis verification, chemoembolization and surgical treatment were performed. Disease progression began in 2023. Based on the progression, chemotherapy in combination with durvalumab was initiated. In the case of local progression, a course of stereotactic radiotherapy was administered. This clinical case demonstrates the results of combining systemic therapy and local control methods. Progression-free survival with durvalumab therapy was 26 months. Thus, this option demonstrated the potential of modern immunochemotherapy and stereotactic radiotherapy.