# Case Report: Dual checkpoint inhibition with bevacizumab yields dramatic response in synchronous double primary HCC and ICC with lung metastasis

## TL;DR

A rare case of liver cancer with lung spread showed dramatic improvement using a combination of immunotherapy drugs.

## Contribution

This is the first reported case of successful systemic therapy for unresectable double primary liver cancer.

## Key findings

- Combination immunotherapy led to complete remission of lung metastases and partial response in liver tumors.
- The patient achieved long-term favorable outcomes after surgery and adjuvant therapy.
- Dual checkpoint inhibition with bevacizumab shows promise for treating sdpHCC-ICC.

## Abstract

Due to its rarity, synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma (sdpHCC-ICC) presents significant challenges for preoperative diagnosis and is lacking established systemic therapies. Here, we present an extremely rare case of unresectable collision-type sdpHCC-ICC with pulmonary metastases, who achieved significant responses in both pulmonary metastases and hepatic lesions following combination immunotherapy.

This case report describes a 69-year-old male diagnosed with collision-type sdpHCC-ICC accompanied by pulmonary metastases. The patient underwent combination immunotherapy with dual immune therapy of nivolumab plus ipilimumab and bevacizumab, achieving complete remission (CR) of pulmonary lesions and partial response (PR) in hepatic lesions. Subsequent surgical resection of the residual liver tumor and postoperative adjuvant therapy resulted in favorable long-term outcomes.

Our study reports the first case that systematic therapy achieved successful conversion therapy in an unresectable sdpHCC-ICC. Combination immunotherapy might represent a promising therapeutic strategy for sdpHCC-ICC, warranting further validation.