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Case Histories

Unique Clinical Experience Gives Patient Another Chance When Options Seemed Exhausted

A multifocal unresectable cholangiocarcinoma treated with neoadjuvant chemotherapy and ultimately undergoing a resection.

Patient History:

  • Patient is a 57-year-old male who was diagnosed with granular cell tumor in 2004 status post excision. Patient noted an axillary mass in August 2005, which was excised, and there was evidence of lymph node involvement consistent with metastatic granular cell tumor and treated with adjuvant doxorubicin.
  • In 2006 he was noted to have lung nodules and subsequently observed in May of 2007 with progressive disease. Doxorubicin was initiated but the patient had an infusion reaction and therefore was discontinued. The patient then began treatment with gemcitabine and after 5 cycles he had only a minimal response.
  • In December 2007 he received local radiation to expanding right axillary mass. In December 2008 he received additional radiation to expanding right mass in January 2009 he noted an enlarged supraclavicular mass he was treated on trial with Brivanib . This was discontinued because of intractable hypertension.
  • In February 2009 the patient received two cycles of ifosfamide but on follow-up imaging had progressive disease. In March 2009 he began radiation to the enlarging supraclavicular mass. In July 2009 the patient was started on the clinical trial of 5 days on Temodar. In August 2009 he was taken off study because of disease progression. The patient was told that there are no further options and he should pursue hospice and thenn self-referred to Bruckner oncology.

Patient Challenge:

  • Heavily pretreated and his tumor was growing despite multiple treatments with radiation.
  • Not eligible for any further clinical trial.
  • Not offered any further chemotherapy at a prominent academic cancer center.

Clinical Treatment Plan:

  • The patient started treatment on a low-dose multidrug regimen combining the most active agents for his disease in a tolerable regimen.


The patient has been on treatment for over one year and 6 months. At first he appeared to have stable disease and the regimen was adjusted by substituting 2 chemotherapy drugs in the 6 drug regimen and the doses of drugs were titrated up slowly and carefully as tolerated.. After 6 to 8 cycles there was significant improvement in the primary site, including an almost complete resolution of the lesion of his upper arm that had been bulging out (now with smooth skin and some scarring). The pulmonary metastasis has also diminished in size. The patient continues on low dose maintenance chemotherapy, which he is tolerating well despite his long history of treatment.

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