Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):403-407. 10.14701/ahbps.2019.23.4.403.

Long term recurrence free survival in a stage IV gallbladder cancer treated with chemotherapy plus trastuzumab and salvage liver resection

• Prieto M
• Gastaca M
• Ruiz P
• Ventoso A
• Palomares
• Perfecto A
• Valdivieso A

• KMID: 2464332
• DOI: http://doi.org/10.14701/ahbps.2019.23.4.403

Abstract

Surgery is the only treatment for biliary tract cancer with long term survival. Unfortunately, most patients are diagnosed at stage IV with distant metastases. In these circumstances, life expectancy is less than one year due to aggressive tumour biology and a lack of effective systemic therapies. HER2 overexpression or amplification is predominantly seen in extrahepatic cholangiocarcinoma and gallbladder cancer (10-18%) and rarely in intrahepatic cholangiocarcinoma (1%). Trastuzumab is a monoclonal antibody that targets HER-2. We present a clinical case with a stage IV gallbladder cancer (liver and interaortocaval lymph node metastases), which presented progression during first-line chemotherapy treatment, which prompted a change in therapy to study the Her 2/Neu mutation which showed an intense positive overexpression. A combination of HER2/Neu-directed therapy (Trastuzumab) with second-line chemotherapy, was able to achieve a long term complete radiological, metabolic, and biochemical response. A curative intention surgery was performed and the patient is alive and recurrence-free at five years. To the best of our knowledge, we present a case which is the first report of a patient with a Stage IV gallbladder cancer who achieved a five-year survival without recurrence after a conversion therapy combining chemotherapy plus Trastuzumab and radical salvage surgery.

Keyword

Bile duct cancer; Gallbladder cancer; Conversion surgery; Her-2; Trastuzumab

MeSH Terms

Bile Duct Neoplasms
Biliary Tract Neoplasms
Biology
Cholangiocarcinoma
Drug Therapy*
Gallbladder Neoplasms*
Gallbladder*
Humans
Intention
Life Expectancy
Liver*
Lymph Nodes
Neoplasm Metastasis
Recurrence*
Trastuzumab*
Trastuzumab

Figure

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  Fig. 1 Potentially genetic alterations and targered therapies.

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  Fig. 2 CT: GBC with liver infiltration, yellow circle, (A) and liver metastases, yellow circle (B). Complete radiological response (C and D).

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  Fig. 3 (A) CDK7+, (B) CDK20−, (C) CDX2+.

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  Fig. 4 Biological response.

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