病例报告:无法切除的肝内胆管癌的转化治疗:Tislelizumab、Lenvatinib 和 GEMOX 在一个病例中的应用

He-wei Zhang, Hai-bo Yu
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摘要

肝内胆管细胞癌(ICC)是最常见的浸润性恶性肿瘤之一。目前,ICC 采用根治性手术切除治疗。我们报告了一例晚期ICC患者,由于肿瘤侵犯肝脏血管,患者无法接受根治性手术。吉西他滨和奥沙利铂(GEMOX)方案联合替斯利珠单抗免疫疗法和仑伐替尼靶向治疗8个周期后,肿瘤明显缩小,血管侵犯消失。CA19-9水平降至正常水平。患者的病情得到部分缓解,肿瘤成功转化。该患者成功接受了根治性手术切除,包括胆囊切除,肝IV、V、VIII段切除,以及区域淋巴清扫术,病理完全缓解。GEMOX方案联合Tislelizumab和仑伐替尼具有良好的抗肿瘤疗效和安全性,可能是晚期ICC可行且安全的转化治疗方案。
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Case report: Translational treatment of unresectable intrahepatic cholangiocarcinoma: Tislelizumab, Lenvatinib, and GEMOX in one case
Intrahepatic cholangiocellular carcinoma (ICC) is one of the most common invasive malignancies. Currently, ICC is treated with radical surgical resection. However, the majority of patients are diagnosed at an advanced stage, making surgery ineligible for them.We present a case of advanced ICC, which could not undergo radical surgery due to tumor invasion of liver blood vessels. The gemcitabine and oxaliplatin (GEMOX) regimen combined with Tislelizumab immunotherapy and Lenvatinib targeted therapy for 8 cycles resulted in significant tumor shrinkage significantly and the vascular invasion disappeared. CA19–9 levels were reduced to normal levels. Partial remission and successful tumor transformation were achieved. The patient underwent a successful radical surgical resection, including cholecystectomy, resection of liver segments IV, V, and VIII, as well as a regional lymphatic dissection procedure, resulting in complete pathological remission.Tumor-free surgical margins (R0) resection of patients with advanced ICC after combination of immune, targeted and chemotherapy is rare, and there are almost no cases of complete postoperative remission. The GEMOX regimen in combination with Tislelizumab and Lenvatinib has a good antitumor efficacy and safety profile, and may be a feasible and safe translational treatment option for advanced ICC.
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