Complete Response to Combined Chemotherapy and Anti-PD-1 Therapy for Recurrent Gallbladder Carcinosarcoma: A Case Report and Literature Review

Qin-Qin Liu, Hao-Ming Lin, Hong-Wei Han, Cai-Ni Yang, Chao Liu, Rui Zhang, Qin-Qin Liu, Hao-Ming Lin, Hong-Wei Han, Cai-Ni Yang, Chao Liu, Rui Zhang

Abstract

Background: Gallbladder carcinosarcoma (GBCS) is a rare and aggressive malignancy with extremely poor prognosis. Although surgery is regarded as the primary therapy for GBCS, the effective therapeutic strategies for unresected lesions have been poorly defined.

Case presentation: We presented a case of a 74-year-old male who underwent radical resection of gallbladder carcinoma at a local hospital. Seven months later, he was admitted to our hospital due to right upper abdominal discomfort. Postoperative radiological examinations showed multiple hepatic lesions, hilar lymph node metastasis, and main portal vein tumor thrombus. The pathological consultation results confirmed GBCS and immunohistochemical examinations revealed PD-L1 expression in 20% of tumor cells. Then, the patient received chemotherapy (Gemcitabine plus Oxaliplatin, GEMOX) in combination with anti-PD-1 therapy. After nine courses of the combination therapy, complete regression of the tumors was achieved with no evidence of relapse till now.

Conclusions: We, for the first time, reported a patient with recurrent GBCS who benefited from the combined chemotherapy and immunotherapy, providing a potential effective management strategy for the refractory malignant tumor.

Keywords: anti-PD-1 therapy; chemotherapy; combination therapy; complete response; recurrent gallbladder carcinosarcoma.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Liu, Lin, Han, Yang, Liu and Zhang.

Figures

Figure 1
Figure 1
The evaluation of tumor response during the clinical course. (A) Pretreatment computed tomography (CT) revealed recurrent lesions in the segment IV (red circle), V (blue circle) and IV/VIII (green circle) of the liver, and a metastatic lesion in the hepatic hilum with tumor thrombus in the main portal vein (yellow circle). (B) After two courses of combination therapy, CT showed the intrahepatic lesions decreased in size, and both the lesion in the hepatic hilum and the main portal vein tumor thrombus disappeared. (C) After six courses of combination therapy, CT showed complete resolution of all the lesions.
Figure 2
Figure 2
Histologically, the tumor tissue was composed of poorly differentiated adenocarcinoma and spindle cell sarcoma (A) (Hematoxylin and eosin stain, x100). Immunohistochemical examination revealed positive staining for CK in the carcinomatous and sarcomatous components (B), PD-L1-positive expression in the sarcomatous components (C), and PD-L1-negative expression in the carcinomatous components (D) (Immunohistochemical stain, x100).
Figure 3
Figure 3
The patient’s timeline of surgery, treatment, and tumor response. PR, partial response; CR, complete response.

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