Long-Term Response to Gemcitabine, Cisplatin, and Nab-Paclitaxel Followed by Maintenance Therapy for Advanced Gallbladder Cancer: A Case Report and Literature Review.
Long-Term Response to Gemcitabine, Cisplatin, and Nab-Paclitaxel Followed by Maintenance Therapy for Advanced Gallbladder Cancer: A Case Report and Literature Review.
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DOI：
10.3389/fonc.2021.733955
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发表时间：
2021
影响因子：
4.7
通讯作者：
Zhu Q
中科院分区：
文献类型：
--
作者：
Liu T;Li Q;Zhang W;Zhu Q
胆囊癌（GBC）是胆道癌（BTC）中最常见和最具破坏性的肿瘤类型，预后较差。根据II期试验的结果，目前认为吉西他滨、顺铂加nab-紫杉醇的新联合方案是晚期BTC患者的有效选择。此外，一线治疗后的维持治疗已被证明可改善各种实体瘤的疾病控制率，但尚未对GBC患者进行评估。我们在此报告的情况是，转移性GBC患者接受三联药物方案治疗，随后接受卡培他滨或S-1维持治疗，获得长期生存获益。一名68岁男性被诊断为胆囊腺癌伴肝、肠系膜上和腹部淋巴结转移（cT3N2M1，IVB期）。吉西他滨和顺铂化疗5个周期后达到部分缓解（PR）。另外三个周期的白蛋白结合型紫杉醇加吉西他滨-顺铂方案产生了所有肿瘤病变的完全反应。随后给予卡培他滨维持治疗，随后给予S-1，患者的无病生存期为15个月。此外，当疾病进展时，患者仍然对这种三联药物方案有反应，在两个化疗周期后达到PR。总体而言，治疗方案耐受性良好，未发生3级或更高级别的不良反应。值得注意的是，血清碳水化合物抗原199（CA199）水平与治疗反应密切相关，并且在随访期间PET-CT发现病变之前升高。我们的研究结果表明，在吉西他滨-顺铂方案中加入白蛋白结合型紫杉醇可能会对晚期GBC患者产生良好的疗效。一线治疗后进一步使用卡培他滨或S-1维持治疗似乎是这些患者的合理选择，在治疗和随访期间监测CA199水平是有价值的。
Gallbladder cancer (GBC) is the most common and devastating tumor type of biliary tract cancer (BTC) with poor outcomes. A new combined regimen of gemcitabine, cisplatin, plus nab-paclitaxel is currently considered an effective option for patients with advanced BTC following the results of a phase II trial. In addition, maintenance therapy after first-line treatment has been shown to improve disease control rate of various solid tumors but has not been evaluated for GBC patients. The scenario we report herein is of a metastatic GBC patient treated with the triple-drug regimen followed by maintenance therapy with capecitabine or S-1, who achieved a long-term survival benefit. A 68-year-old man was diagnosed with gallbladder adenocarcinoma with liver, supra-diaphragmatic, and abdominal lymph node metastases (cT3N2M1, stage IVB). Partial response (PR) was achieved after five cycles of gemcitabine and cisplatin chemotherapy. A further three cycles of nab-paclitaxel plus gemcitabine-cisplatin regimen yielded a complete response of all tumor lesions. Subsequent administration of maintenance therapy with capecitabine followed by S-1 achieved a disease-free survival of 15 months for the patient. Moreover, the patient remained responsive to this triple-drug regimen when the disease progressed, achieving PR after two cycles of chemotherapy. Overall, the treatment regimens were well tolerated with no grade 3 or higher adverse effects occurring. Notably, the serum carbohydrate antigen 199 (CA199) levels were closely related to the treatment response and increased before the lesions were found on PET-CT during follow-up. Our findings suggested that adding nab-paclitaxel into gemcitabine-cisplatin regimen may result in a favorable efficacy in patients with advanced GBC. Further maintenance therapy with capecitabine or S-1 after first-line therapy appeared to be a reasonable option for these patients, and it is valuable to monitor CA199 levels during treatment and follow-up.
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