Salvage resection for FGFR2 fusion-positive intrahepatic cholangiocarcinoma after pemigatinib therapy: a case report and literature review.

BACKGROUND: The incidence of intrahepatic cholangiocarcinoma (iCCA) is rising. Unfortunately, most patients present with locally advanced or metastatic disease at initial diagnosis, making them ineligible for surgical resection. Currently, the standard first-line treatment for unresectable iCCA is gemcitabine plus cisplatin combined with durvalumab or pembrolizumab, but the survival benefit remains limited. Pemigatinib is recommended as the treatment of previously treated advanced iCCA with FGFR2 fusion or rearrangement. The favorable objective response rate in FIGHT-302 study highlights its potential in salvage resection following tumor shrinkage and downstaging. Salvage resection has been implemented in various initially unresectable malignancies, significantly improving patient prognosis. To date, few reports have described salvage resection following FGFR inhibitor therapy for FGFR2 fusion-positive iCCA.

CASE PRESENTATION: A 66-year-old female diagnosed with locally advanced iCCA harboring FGFR2 fusion received 5 cycles of pemigatinib treatment after a multidisciplinary team discussion. The efficacy was assessed as partial remission per the Response Evaluation Criteria in Solid Tumors version 1.1, and the patient underwent a laparoscopic left hepatectomy guided by indocyanine green fluorescence. During the treatment, there was no evidence of severe adverse events and postoperative complications. The patient remained recurrence-free at the last follow-up of 30 months postoperatively.

CONCLUSION: This is the first report of salvage resection following first-line pemigatinib monotherapy for FGFR2 fusion-positive locally advanced iCCA, with promising efficacy and acceptable safety.