Introduction
Liver cancer has become the second and sixth most common cause of cancer-associated deaths in men and women (1). Hepatocellular carcinoma (HCC) accounts for 75–85% of patients with liver cancer and is a major health burden worldwide (2,3). Intrahepatic cholangiocarcinoma (ICC) is a malignant neoplasm occurring in the epithelium of the biliary tract and the second most common primary liver cancer following HCC, accounting for approximately 15% of primary liver cancers and 3% of gastrointestinal tumors (4,5). Since ICC is often asymptomatic in its early stages and detected in advanced stages, curative therapy cannot be identified in many patients with ICC. Chemotherapy is the primary treatment for patients with advanced stage with the combination of gemcitabine and cisplatin (GC therapy); the combination of gemcitabine and S-1; and the triple combination of gemcitabine, cisplatin, and S-1 as the well-established first-line treatment options for unresectable ICC (6–8). However, no effective second-line chemotherapy has been established due to insufficient clinical benefits (9,10).
Recently, comprehensive genomic profiling (CGP) has been approved and used in clinical practice. It can detect genetic alterations, may verify alternative treatment options, and achieve personalized treatment by inhibiting specific molecular drivers in critical signaling pathways (11). Fibroblast growth factor receptor 2 (FGFR2) fusion is found in ICC and occurs in up to approximately 10–20% of patients (4). Pemigatinib is an FGFR1-, FGFR2-, and FGFR3-selective inhibitor and is currently approved for the treatment of previously treated unresectable ICC with FGFR2 fusion (12). However, reports on using pemigatinib for the treatment of ICC are limited. Herein, we reported the case of a 53-year-old woman with stage IVB ICC who was treated with pemigatinib. In this case, there are two points worth mentioning: the liquid CGP was useful for detecting FGFR2 fusion and the patient experienced typical side effects of pemigatinib that required treatment.