Introduction
Primary liver cancer is the sixth-most commonly diagnosed cancer and the third leading cause of cancer death worldwide, with an estimated 906,000 new cases and 830,000 deaths annually 1. Combined hepatocellular and cholangiocarcinoma (CHC) is a rare form of primary liver cancer that shows the histopathological features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma within the same tumor 2,3. Surgical treatment may be preferred for patients with localized disease 4,5. However, the disease commonly recurs during the post-operative observation, often with unresectable regional or distant or metastatic disease6-8. In addition, the number of patients receiving surgical treatment is limited, according to a large population-based study 9.
No standard systemic chemotherapy for unresectable patients has yet been established, as evidence has been limited due to the rarity and the heterogeneity of the disease. Accordingly, physicians offer a biliary tract cancer-based regimen or an HCC-based regimen for advanced CHC patients. There have been some studies exploring the efficacy and safety of certain regimens, including gemcitabine plus cisplatin, fluorouracil plus cisplatin, and sorafenib 10-12, but these studies were reported in a retrospective manner.
Recently, atezolizumab and bevacizumab (Atez/Bev), which is a combination therapy of anti-programmed death ligand-1 (PD-L1) and anti-vascular endothelial growth factor (VEGF), was introduced as the first immune-combined therapy for patients with HCC and showed advantages over sorafenib in terms of the overall and progression-free survival 13. However, the efficacy and safety of Atez/Bev for patients with CHC remains uncertain.
We herein report a case of unresectable CHC successfully treated with Atez/Bev.