YO5 - Complete Radiologic and Pathologic Response in a Metastatic Gallbladder Adenocarcinoma Patient treated with Checkpoint Inhibitor/Chemotherapy Combination: A Case Report

Case summary

Complete Response in a Metastatic Gallbladder Adenocarcinoma Patient treated with Checkpoint Inhibitor/Chemotherapy Combination: A Case Report

Gallbladder Carcinoma is a rare malignancy with an overall incidence of 3 per 100,000. Prognosis is poor with a median overall survival of 11.7 months. This is attributed to aggressive tumor biology and advanced stages at diagnosis. The standard treatment of advanced gallbladder carcinoma is gemcitabine-based combination (gemcitabine-cisplatin). Recently, the superiority of adding the immune checkpoint inhibitor durvalumab to gem/cis was shown in the TOPAZ-1 trial. This case report highlights promising results on the use of durvalumab in advance gallbladder adenocarcinoma.

This is a case of a 64-year-old male who presented with abdominal pain. CT scan of the whole abdomen revealed cholecystolithiasis with cholecystitis, intraluminal hyperdense mass, consider gallbladder malignancy. Patient underwent exploratory laparotomy with frozen section biopsy which showed peritoneal fluid positive for adenocarcinoma. Intraoperatively, the gallbladder mass was unresectable, with a post operative diagnosis of Gallbladder Adenocarcinoma Stage IV. Subsequently, the patient was treated with Durvalumab (1500mg on day 1), Gemcitabine (1000mg/m² on days 1 and 8) and cisplatin (25mg/m² on days 1 and 8) every 3 weeks for 8 cycles.

After 8 cycles of systemic chemotherapy, a follow-up CT scan revealed complete regression of the intraluminal gallbladder mass. PET/CT scan also showed no evidence of hypermetabolic recurrent and metastatic disease. Patient underwent resection of the gallbladder mass with pathologic findings of negative for residual tumor cells, chronic cholecystitis with mucosal erosion and chemotherapy induced histologic changes.

This case report highlights the rare but possible complete pathologic response with the use of immune checkpoint inhibitor durvalumab and gemcitabine/cisplatin combination in advanced gallbladder adenocarcinoma. This is consistent with results of the TOPAZ1 trial demonstrating promising efficacy and improved outcomes with checkpoint inhibitors.

Clinical trial identification

Editorial acknowledgement