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Published on: September 12, 2019
Durable response to sotorasib in KRAS G12C-mutant intrahepatic cholangiocarcinoma: a case report
Chaoxing Liu1, Kang Li1, Jingjian Feng1
1Department of Radiation Oncology, Shijiazhuang People's Hospital, Shijiazhuang, Hebei Province, China.
Abstract:
KRAS G12C mutations are rare in intrahepatic cholangiocarcinoma (iCCA), occurring in approximately 1% of cases. While adagrasib has shown efficacy in biliary tract cancers in clinical trials, real-world evidence for sotorasib remains limited. We report a 64-year-old male with advanced iCCA harboring a KRAS p.(G12C) mutation (58.07% allelic frequency) who progressed on multiple prior therapies including chemotherapy, immunotherapy, and targeted therapy. Disease progression was complicated by obstructive jaundice and the Eastern Cooperative Oncology Group (ECOG) performance status deterioration to 3, requiring percutaneous transhepatic cholangiodrainage (PTCD). Following initiation of sotorasib 480 mg daily, the patient achieved a marked partial radiographic response within 6 weeks. CA19-9 normalized, jaundice resolved, PTCD was removed, and performance status improved to ECOG 1. The patient received continuous sotorasib for 10 months, with the initial partial response lasting 8 months with no significant treatment-related adverse events. This case provides real-world evidence that sotorasib can induce durable responses in chemotherapy-refractory, KRAS G12C-mutant iCCA, including in patients with poor performance status and obstructive jaundice who would typically be excluded from clinical trials.
Insights
Sotorasib demonstrated significant efficacy in a patient with advanced intrahepatic cholangiocarcinoma (iCCA) harboring a KRAS G12C mutation. This case highlights sotorasib
Area of Science:
- Oncology
- Molecular Biology
- Gastroenterology
Background:
- KRAS G12C mutations are uncommon in intrahepatic cholangiocarcinoma (iCCA).
- Limited real-world data exists for sotorasib in biliary tract cancers.
- Patient had advanced iCCA with KRAS p.(G12C) mutation, progressing on multiple prior treatments.
Purpose of the Study:
- To report the efficacy of sotorasib in a patient with advanced KRAS G12C-mutant iCCA.
- To provide real-world evidence for sotorasib in a challenging patient population.
Main Methods:
- A 64-year-old male with advanced iCCA and KRAS p.(G12C) mutation was treated with sotorasib 480 mg daily.
- Patient had obstructive jaundice and ECOG performance status of 3, requiring percutaneous transhepatic cholangiodrainage (PTCD).
Main Results:
- Sotorasib induced a partial radiographic response within 6 weeks.
- Tumor marker CA19-9 normalized, jaundice resolved, PTCD was removed, and performance status improved to ECOG 1.
- The patient achieved a durable response lasting 8 months, with continuous sotorasib for 10 months without significant adverse events.
Conclusions:
- Sotorasib can induce durable responses in chemotherapy-refractory, KRAS G12C-mutant iCCA.
- This includes patients with poor performance status and obstructive jaundice.
- This case provides valuable real-world evidence supporting sotorasib use in iCCA.
