# Systemic therapy with pemigatinib and sintilimab followed by resection for recurrent FGFR-2-positive intrahepatic cholangiocarcinoma: a case report

## TL;DR

A patient with recurrent FGFR-2-positive intrahepatic cholangiocarcinoma was successfully treated with systemic therapy followed by surgery.

## Contribution

This case report demonstrates the potential of FGFR2-targeted systemic therapy to enable curative resection in recurrent ICC.

## Key findings

- Systemic therapy with pemigatinib and sintilimab led to tumor regression and successful R0 resection.
- The patient remained recurrence-free for 19 months after surgery.
- Targeted therapy enabled treatment of a tumor near critical structures.

## Abstract

Fibroblast growth factor receptor-2 (FGFR-2) mutations are frequently observed in intrahepatic cholangiocarcinoma (ICC). While FGFR2-targeted therapies are primarily studied in advanced ICC, this report presents a rare case of locally recurrent ICC treated with systemic therapy, leading to significant tumor regression and successful R0 resection.

A 51-year-old female underwent right posterior hepatectomy and cholecystectomy in 2018 for ICC. In August 2022, postoperative MRI revealed tumor recurrence near the hepatic vein, accompanied by intrahepatic bile duct dilation and a tumor thrombus. Given the tumor’s proximity to critical structures and confirmed FGFR-2 fusion, systemic therapy with pemigatinib and sintilimab was initiated. After four cycles, the tumor showed partial remission, with a reduction in the bile duct tumor thrombus. In May 2023, the patient underwent successful right hemi-hepatectomy. Postoperatively, she continued combination therapy without recurrence or metastasis for 19 months.

This case highlights the efficacy of pemigatinib-based systemic therapy in achieving tumor regression and enabling curative resection in locally recurrent FGFR-2-positive ICC. The successful outcome underscores the potential of targeted therapies in managing recurrent ICC, warranting further investigation.