# Response to trametinib, hydroxychloroquine, and bevacizumab in a young woman with NRAS-mutated metastatic intrahepatic cholangiocarcinoma: a case report

## TL;DR

A young woman with a rare liver cancer mutation responded to a combination of three drugs, but the effect was temporary.

## Contribution

This case report explores a novel combination therapy for NRAS-mutated cholangiocarcinoma.

## Key findings

- The patient showed a 25% reduction in tumor size after 2 months of triple therapy.
- The treatment response lasted 4 months before the cancer progressed.
- The case suggests potential for MEK and autophagy inhibition in RAS-mutated tumors.

## Abstract

Systemic chemotherapy is the main treatment option for patients with advanced intrahepatic cholangiocarcinoma (iCCA), however, its efficacy is limited. Herein, we report a young patient with NRAS-mutated chemoresistant metastatic iCCA, who received second-line therapy with a combination of trametinib (MEK1/2 inhibitor), hydroxychloroquine (autophagy inhibitor), and bevacizumab (angiogenesis inhibitor). A significant response was achieved during therapy, resulting in a 25% decrease in the size of tumor lesions after 2 months of treatment and an improvement in the patient’s condition. The duration of this response was 4 months, but the patient died 10 months after the initiation of this triple therapy. This case report and the analysis of other available studies warrant further investigations on combined MEK and autophagy inhibition in RAS-mutated tumors.