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Long term recurrence free survival in a stage IV gallbladder cancer treated with chemotherapy plus trastuzumab and salvage liver resection
Ann Hepatobiliary Pancreat Surg 2019 Nov;23(4):403-7
Published online November 30, 2019;  https://doi.org/10.14701/ahbps.2019.23.4.403
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Mikel Prieto1,2, Mikel Gastaca1,2, Patricia Ruiz1, Alberto Ventoso1, Ibone Palomares1, Arkaitz Perfecto3, and Andrés Valdivieso1,2

1Hepatobiliary Surgery and Liver Transplantation Unit, General and Digestive Surgery Department, Cruces University Hospital, 2University of the Basque Country, 3General and Digestive Surgery Department, Cruces University Hospital, Bilbao, Spain
Received April 20, 2019; Accepted July 11, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Surgery is the only treatment for biliary tract cancer with long term survival. Unfortunately, most patients are diagnosed at stage IV with distant metastases. In these circumstances, life expectancy is less than one year due to aggressive tumour biology and a lack of effective systemic therapies. HER2 overexpression or amplification is predominantly seen in extrahepatic cholangiocarcinoma and gallbladder cancer (10-18%) and rarely in intrahepatic cholangiocarcinoma (1%). Trastuzumab is a monoclonal antibody that targets HER-2. We present a clinical case with a stage IV gallbladder cancer (liver and interaortocaval lymph node metastases), which presented progression during first-line chemotherapy treatment, which prompted a change in therapy to study the Her 2/Neu mutation which showed an intense positive overexpression. A combination of HER2/Neu-directed therapy (Trastuzumab) with second-line chemotherapy, was able to achieve a long term complete radiological, metabolic, and biochemical response. A curative intention surgery was performed and the patient is alive and recurrence-free at five years. To the best of our knowledge, we present a case which is the first report of a patient with a Stage IV gallbladder cancer who achieved a five-year survival without recurrence after a conversion therapy combining chemotherapy plus Trastuzumab and radical salvage surgery.
Keywords : Bile duct cancer; Gallbladder cancer; Conversion surgery; Her-2; Trastuzumab

 

November 2019, 23 (4)