Systemic therapy for unresectable, mixed hepatocellular-cholangiocarcinoma: treatment of a rare malignancy

Combined hepatocellular-cholangiocarcinoma (HCC-CC) represents a small percentage (0.4–4.7%) of primary hepatic malignancies (1-3). Given the rarity of this disease, there are no clear treatment guidelines for advanced HCC-CC. The World Health Organization defines this malignancy as a tumor unequivocally admixed with both hepatocellular and CC (3). Surgical resection is the mainstay curative option; however, higher recurrence rates and shorter disease-free survival in HCC-CC have been reported compared to each separate malignancy (2,4-6). Liver transplantation appears to have poorer survival for combined HCC-CC in relation to HCC alone, although results are conflicting (2,7,8). Systemic therapy experience is limited to small case reports with regimens including sorafenib, doxorubicin + cisplatin, gemcitabine + cisplatin, fluorouracil monotherapy, and fluorouracil + oxaliplatin (9,10). With our case series, we aim to add to the existing knowledge with our institutional experience