Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2025; 17(7): 108650
Published online Jul 15, 2025. doi: 10.4251/wjgo.v17.i7.108650
Pathological complete response in advanced intrahepatic cholangiocarcinoma was achieved through tri-modal therapy: A case report and review of literature
Ju-Ping Xie, Ya-Jun Tang, You-Wen Fan, Ying-Zi Huang, Min Deng, Tian-Zhi Zhang, You Li, Gang Deng, Di Tang
Ju-Ping Xie, Ya-Jun Tang, You-Wen Fan, Ying-Zi Huang, Min Deng, You Li, Gang Deng, Di Tang, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
Tian-Zhi Zhang, Department of Pathology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
Di Tang, Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
Co-first authors: Ju-Ping Xie and Di Tang.
Author contributions: Tang D conceptualized the study, designed the methodology (design of the tri-modal therapy approach), and administrated the project; Xie JP and Tang D performed patient diagnosis and treatment planning; Xie JP, Tang YJ, Fan YW, Deng G, and Tang D performed surgical intervention; Tang YJ managed complications; Zhang TZ performed pathology assessment and interpretation of pathology results; Tang YJ, Fan YW, Huang YZ, and Deng M collected clinical data; Huang YZ, Deng M, and Li Y were involved in patient management; Xie JP and Tang D wrote, reviewed, and edited the manuscript, and prepared the tables and figures. Xie JP and Tang D contributed equally to case investigation, writing-review & editing, and preparation of tables and figures, therefore, designated as co-first authors.
Supported by Shenzhen Clinical Research Center for Gastroenterology (Gastrointestinal Surgery), No. LCYSSQ20220823091203008.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report, including clinical details and treatment outcomes. All data have been anonymized to ensure patient confidentiality. The patient was fully informed about the purpose of the publication and provided consent voluntarily, in compliance with the Declaration of Helsinki.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Di Tang, Associate Chief Physician, Director, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong Province, China. tangdi@mail.sysu.edu.cn
Received: April 21, 2025
Revised: May 19, 2025
Accepted: June 4, 2025
Published online: July 15, 2025
Processing time: 85 Days and 21.4 Hours
Abstract
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.

Keywords: Intrahepatic cholangiocarcinoma; Hepatic arterial infusion chemotherapy; Lenvatinib; Toripalimab; Surgery; Case report

Core Tip: This report details an unresectable advanced intrahepatic cholangiocarcinoma (ICC) patient treated with first-line GEMOX-HAIC, lenvatinib, and toripalimab. This tri-modal therapy led to successful R0 resection and complete pathological remission. The patient achieved 29 months of disease-free survival. This rare case highlights a regimen enabling surgical resection and long-term survival in advanced ICC and discusses multidisciplinary management of severe biliary complications. However, as a single case, generalizability is limited. The regimen's efficacy and safety warrant validation in prospective, multi-center clinical trials.