Immunotherapy-Facilitated Conversion Surgery for Biliary Tract Cancer: A Case Series of Long-Term Survivors Following Durvalumab Combined With Gemcitabine and Cisplatin.

BACKGROUND

Conversion surgery after systemic therapy is gaining attention in biliary tract cancer (BTC), yet evidence under gemcitabine, cisplatin, and durvalumab (GCD) remains scarce.

CASE PRESENTATION: We report three patients with initially unresectable BTC (two gallbladder cancers and one intrahepatic cholangiocarcinoma) who underwent curative surgery following GCD therapy. All patients received six to eight cycles of GCD, achieving significant tumor control. Radiologic responses included tumor regression, nodal clearance, and vascular detachment. Surgery consisted of extended hepatectomy or cholecystectomy with bile duct resection. All patients achieved R0 resection. One patient developed severe postoperative complications requiring intensive care unit (ICU) management; however, the patient recovered with appropriate treatment, whereas the remaining patients had no major postoperative complications. All patients remain recurrence-free 14-23 months postoperatively.

CONCLUSION

GCD therapy may enable conversion surgery even in advanced BTC with limited metastases. Durable disease control, rather than maximal shrinkage, appears critical for resectability. This case series suggests that immunotherapy-integrated regimens can expand surgical opportunities and improve long-term outcomes in selected patients. Further studies are needed to optimize patient selection.