Mixed CCA/HCC Tumors: A Real Thing

While mixed hepatocellular-cholangiocarcinoma tumors are very rare they are “a real thing,” advised Binbin Zheng-Lin, MD, at the International Society for Gastrointestinal Oncology meeting in Phoenix, Arizona, on October 13.

Dr Zheng-Lin is a hematology/oncology Fellow at the Mayo Clinic Comprehensive Cancer Center in Phoenix, Arizona.

He reviewed a case study of a middle-aged male patient who presented with such severe lower back pain he could not lie flat. The patient had lost 20 pounds in 2 weeks; was previously healthy; and drank modest amounts of alcohol.

Imaging and testing showed a destructive bony mass of the spine at L3 along with lung nodules and a large (10 cm) lesion in the liver, along with additional smaller lesions. His alpha fetoprotein (AFP) leve was very high and immunohistochemistry (IHC) markers were positive for both hepatocellular carcinoma and cholangiocarcinoma.

“This presentation is quite rare,” Dr Zheng-Lin stated. “It’s a real diagnostic challenge and there are no clear guidelines on treatment.” Involving the tumor board and radiology is essential, he noted, and “molecular profiling is critical—if you just follow the guideline, you may miss out!”

When working with patients who have mixed tumors, Dr Zheng-Lin said it’s vital to check regularly with any suboptimal response or progression of disease after initiating treatment. Follow the tumor markers, he advised, to determine which patients to biopsy. “You can do liquid biopsies; tissue is not essential every time.”

The patient in this case received palliative radiation for the spinal mass and initiated treatment with gemcitabine and cisplatin (gem-cis). “He had a pretty good response, showing a drastic drop in AFP,” Dr Zheng-Lin reported. “The tumor remained stable for 6 months before showing any progression.”

When the patient’s tumor progressed, he was enrolled in a clinical trial of the fibroblast growth factor receptor (FGFR) inhibitor pemigatinib. After 2 months of benefit, the disease again showed progression. Since then, the patient has been treated with capmatinib, and participated in the TOPAZ trial of durvalumab plus gem-cis for 3 months.

“The patient is now in another trial with a new FGFR inhibitor and doing well,” he reported.