Durable response to the combination of pembrolizumab and nab-paclitaxel in a metastatic extrahepatic cholangiocarcinoma: A case report and literature review

• Published in: Frontiers in pharmacology Vol. 13; p. 1037646
• Main Authors: Tan, Sirui, Yu, Jing, Huang, Qiyue, Zhou, Nan, Xiong, Xianze, Gou, Hongfeng
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 28.11.2022
• Subjects: cholangiocarcinoma; immunotherapy; nab-paclitaxel; pembrolizumab; Pharmacology; tumor microenvironment; nab-paclitaxel; pembrolizumab; tumor microenvironment; cholangiocarcinoma; immunotherapy
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2022.1037646

Cholangiocarcinoma (CCA) is a highly aggressive malignant tumor with poor overall survival. Although the first-line standard chemotherapy (gemcitabine plus cisplatin) combined with immunotherapy has yielded positive results with survival prolongation, the efficacy remains unsatisfactory, and new treatment modalities need to be explored. We report the case of a patient with metastatic extrahepatic CCA who achieved a durable response and good tolerance to the combination treatment of pembrolizumab and nab-paclitaxel following progression on gemcitabine plus capecitabine chemotherapy. The tumor samples of the patient revealed low TMB, MSS, negative PD-L1 expression, and negative CD8 TIL expression. This patient was treated with 3 cycles of pembrolizumab plus nab-paclitaxel and cisplatin, followed by 5 cycles of pembrolizumab plus nab-paclitaxel. Finally, 10 cycles of pembrolizumab monotherapy were administered. The patient survived for over 27 months after the initiation of combined therapy and was still in continuous remission at the last follow-up. As far as we know, this is the first report that pembrolizumab plus nab-paclitaxel successfully treated a patient with advanced CCA. This combination therapy might be a potential treatment option for patients with cholangiocarcinoma, and further clinical trials are needed to explore the outcomes.