Surgical treatment of stage IV gallbladder cancer after complete radiological, metabolic and biochemical response with chemotherapy and trastuzumab

Abstract

Background: Surgery is the only curative treatment for biliary cancer.Unfortunately most patients are diagnosed at an advanced stage.Current treatments for distant disease include radiation and chemotherapy with exceptional complete response and long-term survival. Trastuzumab is a monoclonal antibody that targets HER-2.Overexpression of HER-2 has been described in gallbladder cancer and cholangiocarcinoma. Methods: We present the first case described of surgical treatment in stage IV gallbladder adenocarcinoma after complete radiological, metabolic and biochemical response. Results: We present a 44-year-old male diagnosed of gallbladder cancer with liver and distant lymph nodes metastases. Ca19.9 22,000 U/ml.Metastases biopsy showed adenocarcinoma with bile duct origin. Cisplatin and Gemcitabine were started with disease progression.Immunohistochemistry showed intense positivity for HER-2.Chemotherapy was swiched to Oxaliplatin and Capecitabine associated to Trastuzumab.Progressively a complete radiological, metabolic and biochemical response was seen.A mesohepatectomy associated with hiliar and interaortocava lymphadenectomy was performed (pT2N0M0).After 3 years no recurrence has been observed. Conclusion: Although, no conclusions can be drawn from a single case, Trastuzumab should be considered in patients with gallbladder adenocarcinoma at advance stage overexpressing HER-2.