Complete response in unresectable HER2+ cholangiocarcinoma with histotripsy and systemic therapy followed by liver transplantation: a case report

Intrahepatic cholangiocarcinoma carries a poor prognosis making its management challenging. Histotripsy is a non-invasive, non-ionizing, and non-thermal therapy that mechanically disrupts tumors through acoustic cavitation. We present the case of a 59-year-old man with locally advanced, multifocal, stage II intrahepatic cholangiocarcinoma who achieved a complete pathologic response in the explanted liver after treatment with histotripsy and systemic drug therapy consisting of gemcitabine, cisplatin, durvalumab, and trastuzumab deruxtecan. This case highlights the potential role of noninvasive histotripsy as a bridging therapy to transplantation in selected patients with cholangiocarcinoma.