IDDF2018-ABS-0013 The combination of pembrolizumab and bevacizumab in the treatment of cholangiocarcinoma brain metastases: case report

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Abstract

Background

Cholangiocarcinoma originates from primary malignant tumours of bile duct epithelial cells. Epidemiology shows a progressive increase in the incidence over the past decade. However, there is still no uniform treatment to the brain metastases of cholangiocarcinoma in China, especially treatment for salvage to patients with encephaledema. Here, we reported the treatment of a patient with cholangiocarcinoma brain metastases and encephaledema by using bevacizumab and pembrolizumab.

Methods

A 68 year old male patient, who underwent cholangiocarcinoma surgery for eight years and suffered from a headache with limited physical activity, was treated at the Chinese People’s Liberation Army Navy General Hospital. The patient was in critical condition and then diagnosed as cholangiocarcinoma brain metastases with obvious cerebral oedema after MRI examination. According to the NCCN guidelines, large segmented intensity modulated radiotherapy (STRB, 84% iso-dose curve, 8Gy/fx4f) to the brain metastases was operated under the guidance of real-time tracking system. The patient was given bevacizumab at 200 mg/time in combination with pembrolizumab at 100 mg/time, once per two weeks after the peripheral blood immune function test. The therapeutic efficacy was evaluated at regular intervals.

Results

MRI examination showed that the patient with obvious cerebral edema before the treatment (figure 1), then the patient’s limb mobility significantly improved After three months of treatment, the cerebral edema significantly shrank, and the local metastases were obviously reduced (figure 2). After six months of continuous treatment, the MRI results showed the local metastatic lesions shrank much smaller than that three months before and maintained at a stable stage (figure 3).

Conclusions

The efficiency of a combination of bevacizumab and pembrolizumab as a therapeutic treatment for cholangiocarcinoma brain metastases patient is remarkable and worthy of further clinical study. Bevacizumab has a certain function on the vascular normalisation, which can effectively enhance the clinical efficacy of immunotherapy. While reversing the surrounding immunosuppressive microenvironment of the tumour has been a new target for tumour therapy, the ‘immunotherapy +molecular target therapy’ for tumour therapy is of more tendency. Such combination has higher precision and lower side effects and will become the future trend for tumour treatment.

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