Pathological complete response in advanced intrahepatic cholangiocarcinoma was achieved through tri-modal therapy: A case report and review of literature.

Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with limited treatment options and a poor prognosis, particularly in unresectable or metastatic cases. Tri-modal strategies combining systemic chemotherapy, targeted therapies, and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.

Case Summary: A 39-year-old male presented with unresectable stage IIIB ICC (cT3N1M0), abdominal pain, and elevated carbohydrate antigen (CA) 19-9 levels. He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy (GEMOX-HAIC), lenvatinib (8 mg daily), and toripalimab (160 mg every three weeks). After five cycles, significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy. Complications, including biliary stenosis and liver abscesses, were managed with biliary stenting and percutaneous drainage, which allowed for the continuation of chemotherapy. Postoperative pathological examination confirmed a pathological complete response. At the last follow-up, the patient had maintained 29 months of disease-free survival post-resection and was continuing postoperative therapy.

Conclusion: This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC, lenvatinib, and toripalimab to convert unresectable ICC to a resectable status, thereby potentially improving patient survival by surgical resection. Further clinical trials investigating this regimen are warranted.