A Turning Point in Intrahepatic Cholangiocarcinoma Bile Duct Cancer: From Progression to Disease Control with ECCT

Rachel Lee Li Ken, a Malaysiian, 51-year-old woman, was diagnosed in May 2025 with intrahepatic cholangiocarcinoma bile duct cancer after elevated tumour markers were found during a routine health screening. Further evaluation revealed a 7–8 cm liver tumour with additional nodules and lymph node involvement, indicating a significant disease burden from the beginning. She started chemotherapy and immunotherapy on 23 June 2025, and early scans showed some tumour shrinkage. However, at the same time, her tumour marker CA 19-9 rose rapidly from 49 to 927, and then to 1306 within weeks, suggesting that despite imaging improvement, the disease remained active. During this period, she also experienced weight loss (55.8 kg to 52.6 kg), mild fatigue, hair thinning, and transient hyperthyroidism.

ECCT was introduced on 20 July 2025 alongside her ongoing treatment, and from that point a clear shift was observed. Her tumour marker, which had been rising aggressively, began to decline steadily, from 1306.6 to 573.7 by November, to 21.1 in December, and to 16.4 in January 2026, returning to normal range. At the same time, imaging continued to improve, with further reduction in tumour size (approximately 7.8 cm to 7.0 cm), decreased metabolic activity, and regression of lymph node involvement. With this level of control, she was able to undergo successful laparoscopic liver resection (segments 5, 6, 7) and lymph node removal in December 2025.

Follow-up imaging in January 2026 showed no new metastatic disease, stable or reduced lymph nodes, no ascites, and no signs of active progression, with only a small indeterminate area requiring monitoring. Her blood parameters also demonstrated recovery and stability, with haemoglobin improving from 10.5 post-surgery to 12.8, liver enzymes normalising after temporary elevation, albumin remaining stable (41–47), and renal function preserved throughout. Clinically, she maintained good appetite and energy, continued daily activities including walking and Qi Gong, and recovered quickly after surgery, being discharged within five days, without significant ongoing side effects.

Her treatment journey combined chemotherapy and immunotherapy (June–October 2025), continuous ECCT from July 2025 onward with progressive optimisation, surgical resection in December 2025, and ongoing maintenance therapy with ECCT. As of her latest follow-up, she remains clinically stable, with normal tumour markers, no evidence of disease progression, and preserved quality of life. Rachel’s case reflects a true turning point, from a phase of ongoing biological activity despite treatment, to sustained disease control.

Following the integration of ECCT alongside ongoing systemic therapy, a consistent pattern of improvement was observed across multiple parameters:

1. Tumour Marker Response (CA 19-9)

A sustained and significant decline was recorded after ECCT initiation:

CA 19-9 Trend:

• Peak: 1306.6 (July 2025)

• Reduced to: 573.7 (Nov 2025)

• Further reduced to: 21.1 (Dec 2025)

• Latest: 16.4 (Jan 2026, within normal range)

This marked normalisation reflects strong biochemical response post-ECCT integration and surgery.

2. Imaging and Disease Control

• Aug → Sept 2025 (Pre-surgery):

  • Reduction in tumour size (from ~7.8 cm to ~7.0 cm)

  • Decreased metabolic activity (SUVmax significantly reduced)

  • Lymph nodes showed reduced uptake and size

• December 2025:

  • Underwent successful laparoscopic liver resection (segments 5, 6, 7) and lymph node removal

• January 2026 (Post-surgery CT):

  • No new metastatic disease

  • Residual lymph nodes stable or reduced

  • No ascites or active progression

  • Only a tiny indeterminate lesion requiring monitoring

Overall: Disease brought under control with no clear progression

3. Blood Parameters and Organ Function

Post-ECCT and post-surgery trends demonstrated recovery and stabilisation:

• Haemoglobin (Hb):

  • Dropped post-surgery (10.5) → recovered to 12.8

• Liver function (AST/ALT/GGT):

  • Temporary post-operative elevation → gradual normalisation

• Albumin:

  • Maintained at healthy levels (41–47), indicating good nutritional and liver reserve

• Renal function:

  • Remained stable throughout

These findings suggest preserved systemic body function despite intensive treatment

4. Clinical Condition and Quality of Life

One of the most notable improvements was in Rachel’s overall well-being:

• Maintained good appetite and energy levels

• Able to continue daily physical activity (walking, Qi Gong)

• Recovered rapidly post-surgery (discharged within 5 days)

• No significant ongoing side effects from treatment

Rachel’s integrated treatment journey included:

• Chemotherapy + Immunotherapy (June–Oct 2025)

• ECCT (initiated July 2025, ongoing)

• Surgical resection (Dec 2025)

• Maintenance Immunotherapy + ECCT (post-surgery)

ECCT was progressively optimised (increased duration and intensity), and maintained consistently through all phases of treatment.

Conclusion

Rachel’s case illustrates a clinically meaningful turnaround following the integration of ECCT into a conventional treatment framework. While initial therapy achieved partial radiological response, the addition of ECCT coincided with:

• Rapid and sustained normalisation of tumour markers

• Continued tumour regression and disease stabilisation

• Preservation of organ function

• Significant improvement in overall quality of life

As of her latest follow-up, she remains clinically stable with no active disease progression, demonstrating how a combined, multidisciplinary approach may enhance both treatment response and patient resilience.