"Intra-hepatic cholangiocarcinoma treated with GEMOX + Cetuximab protocol "

Abstract

New studies show a possible benefit of combining Gemcitabine, Oxaliplatin and Cetuximab for the treatment of intrahepatic tumors. However, there is currently no consensus in the literature. Hence, this article contributes to the debate by presenting a case of cholangiocarcinoma (biliary tract cancer), treated with a modified Gemcitabine, Oxaliplatin and Cetuximab protocol, which evolved to a considerable regression of the tumor and a complete radiologic response assessed by PET-CT Scan. The case report is of a female adult, who presented with a cholangiocarcinoma extending to hepatic segments V and VIII which met unresectable criteria. She was submitted to chemotherapy, consisting of a combination of Gemcitabine, Oxaliplatin and Cetuximab for a prolonged period, followed by a maintenance interval of Cetuximab monotherapy. After the 8th cycle, the patient presented better hepatic biomarker levels; after 15 months of treatment, our team achieved optimal partial radiologic response assesed by PET-CT scan as shown; after 15 months of treatment, a MRI scan showed a reduced and resectable tumor. Our case report suggests use of the Gemcitabine + Oxaliplatin (GEMOX) plus Cetuximab protocol as a neoadjuvant setting for patients with unresectable cholangiocarcinoma. Additionally, our case report confirms the GEMOX plus Cetuximab protocol can be modified according to clinical response so patients can obtain maximum therapeutic gain despite minor or adverse reactions.