Clinical effectiveness of two courses of gemcitabine/cisplatin/durvalumab re-administration after failure of durvalumab maintenance therapy in a patient with intrahepatic cholangiocarcinoma

Introduction: Gemcitabine/cisplatin/durvalumab followed by maintenance durvalumab is the standard treatment of locally advanced or metastatic cholangiocarcinoma (CCA). The clinical benefit of rechallenge for progressing intrahepatic CCA on durvalumab maintenance therapy is currently unknown.

Methods: We report the clinical response to rechallenge of triple therapy after progression on durvalumab maintenance in a patient with intrahepatic CCA.

Results: In August 2021, a 55-year-old female presented with a hepatic lesion in segment VIII and without evidence of metastatic disease. Biopsy-based histology revealed moderately differentiated adenocarcinoma of the intrahepatic bile ducts. The tumor marker CA19-9 was elevated at 538 U/ml. After in situ splitting, complete resection was performed in December 2021, followed by adjuvant therapy with capecitabine for six months. In September 2022, relapse occurred with new unresectable liver lesions and CA19-9 increased to 61 U/ml. After four cycles of gemcitabine/cisplatin/durvalumab followed by five cycles of durvalumab maintenance, partial remission was achieved and CA19-9 normalized. Treatment was discontinued due to grade II fatigue and dizziness, which resolved under maintenance therapy. In August 2023, progression of liver lesions occurred and CA19-9 increased to 998 U/ml. Rechallenge with triple therapy again induced a partial remission and CA19-9 decreased to 32 U/ml. In January 2024, progression of liver lesions with a CA19-9 increase to 209 U/ml was observed after three additional cycles of durvalumab maintenance and a second rechallenge with triple therapy was initiated.

Conclusions: Rechallenge with triple therapy was effective and safe in our patient. This strategy may delay the need for second-line therapy.

Publication History

Article published online:
20 January 2025