Background
Cholangiocarcinoma is a rare but aggressive malignancy, often diagnosed at an advanced stage where curative resection is not feasible. First-line palliative chemotherapy with gemcitabine and cisplatin remains the standard of care. However, the optimal timing for treatment discontinuation following response remains uncertain. We report two cases of advanced cholangiocarcinoma in which chemotherapy was discontinued after achieving a metabolic complete response (CR) confirmed by PET-CT.
Method
We retrospectively reviewed two patients with advanced cholangiocarcinoma who underwent prolonged first-line palliative chemotherapy with gemcitabine and cisplatin. Chemotherapy was discontinued upon confirmation of metabolic CR via PET-CT, and the patients were subsequently monitored for disease progression and overall clinical course.
Result
Case 1: A 70-year-old man was diagnosed with cholangiocarcinoma with liver metastases in 2014. He received gemcitabine-cisplatin chemotherapy for 66 cycles over six years. In 2020, PET-CT showed metabolic CR, and chemotherapy was discontinued. However, progressive disease developed in July 2020. Despite multiple subsequent lines of systemic treatment, the patient transitioned to best supportive care in May 2022.
Case 2: A 71-year-old man presented with epigastric discomfort and was diagnosed with intrahepatic cholangiocarcinoma in 2013. He underwent 41 cycles of gemcitabine-cisplatin over four years. In 2016, PET-CT confirmed metabolic CR, leading to treatment discontinuation. Recurrence was observed in August 2017. Several lines of systemic therapy were administered thereafter, but the patient ultimately transitioned to supportive care.
Conclusion:
These cases highlight the risk of early recurrence following chemotherapy discontinuation, even after achieving metabolic CR in advanced cholangiocarcinoma. Careful consideration is needed in determining the timing of treatment cessation and the role of maintenance strategies. Further research is warranted to define the optimal treatment duration and to identify patients who may benefit from discontinuation or continuation of therapy.