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.