title: Complete Response to Erlotinib and Bevacizumab in a Patient With Biphenotypic (Hepatobiliary) Primary Liver Carcinoma.
abstract: Biphenotypic (hepatobiliary) primary liver carcinomas [B(H-B)PLCs] are rare tumors with features of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). These tumors are associated with a poor overall prognosis and treatment is not well defined. Research over the past 20 years has identified aberrations in several molecular pathways, including epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) in hepatocellular and biliary tract cancers. These discoveries led to the evaluation of targeted therapies, such as tyrosine kinase inhibitors, for the treatment of HCC and ICC. We report a case of a patient with metastatic B(H-B)PLC found to have a single nucleotide variant in the EGFR gene locus R521K who achieved a complete response on imaging after treatment with the combination of an EGFR inhibitor and a VEGF inhibitor. This case prompts consideration of further genomic analysis of these rare tumors and the potential use of targeted therapies in the treatment of patients with B(H-B)PLCs.
authors.affiliation: From the Department of Medicine, Department of Radiology, and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Amy
authors.initials: A
authors.lastname: Zhou
authors.affiliation: From the Department of Medicine, Department of Radiology, and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Manik
authors.initials: M
authors.lastname: Amin
authors.affiliation: From the Department of Medicine, Department of Radiology, and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fowler
authors.affiliation: From the Department of Medicine, Department of Radiology, and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Brunt
authors.affiliation: From the Department of Medicine, Department of Radiology, and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jesse
authors.initials: J
authors.lastname: Keller
authors.affiliation: From the Department of Medicine, Department of Radiology, and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Tan
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D015415:Biomarkers; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D010641:Phenotype; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000068258:Bevacizumab; D000069347:Erlotinib Hydrochloride