Cholangiocarcinoma: treatment with sorafenib extended life expectancy to greater than four years

Cholangiocarcinomas arise from the epithelial cells of intrahepatic and extrahepatic bile ducts. They generally have a very poor prognosis. Many studies report a dismal median survival of approximately 6 months. In this case, we have a patient diagnosed with cholangiocarcinoma who has remarkably exceeded life expectancy to greater than 4 years with a fourth line agent Sorafenib. This is a 51 y/o male who was diagnosed with cholangiocarcinoma approximately 4.5 years ago. After initial work up suggested locally advanced carcinoma, the patient was started on systemic chemotherapy. Despite multiple cycles with GEMOX, capecitabine and 5-FU, the carcinoma progressed. A fourth line agent, Sorafenib, was initiated. This multikinase inhibitor drug is FDA approved for hepatocellular carcinoma and renal cell carcinoma, however the potential efficacy of this agent for treating cholangiocarcinoma is largely unknown. Despite some latest trials suggesting a median survival of 4.4 months, our patient has survived on this chemotherapy agent for almost 4 years now. This case illustrates the potential benefit of using Sorafenib in locally advanced cholangiocarcinoma. This provides hope for more trials, to establish selection criteria for administration of this drug.