Extensive disease of
cholangiocarcinoma (CC) determines the overall outcome and limits curative resection. Despite
chemotherapy, which has been introduced to improve the outcome of biliary tract
malignancies, the benefit in survival is still marginal.
CASE PRESENTATION: We report a 69-year-old patient with non-resectable CC showing hepatic
metastasis and
peritoneal carcinomatosis. Diagnosis was based on computed tomography, mini-laparoscopy and bioptic specimens. Histology revealed an
adenocarcinoma of the biliary tract with expression of epithelial
growth factor receptor. After informed consent the patient received experimental
gemcitabine (1000 mg/m2) every other week and
cetuximab (250 mg/m2) weekly for palliative
chemotherapy. During the reported follow up (since time of first presentation) 20 cycles of
chemotherapy were administered. Relevant
chemotherapy-related toxicity was limited on
gemcitabine-associated side effects. Predominantly, haematological toxicity (CTC, grade 3) and neutropenic
fever (CTC, grade 3) promoted by
catheter-related
sepsis were observed.
Cetuximab caused only mild skin toxicity (CTC, grade 1).
Chemotherapy led to a partial response (> 30% reduction, according to RECIST) of the target lesions and disappearance of the
peritoneal carcinomatosis as shown by computed tomography. Partial response occurred after 17 weeks of treatment and remained stable during the entire course of
chemotherapy for 9.7 months. In parallel, Ca 19-9 serum levels, which were elevated 5-fold at time of diagnosis, returned to normal after 16 weeks of treatment. The performance status stabilized and intravenous alimentation could be discontinued.
CONCLUSION: Our experience from one patient with CC suggests, that a combination of cytotoxic
chemotherapy together with
cetuximab may show promising efficacy in respect to survival and quality of life. Therefore
cetuximab, as a component of palliative
chemotherapy in
biliary tract cancer, needs further evaluation in prospective randomized trials.