Staged approach to overcome hyperbilirubinemia: tailored chemotherapy in liver metastases-a case report

This case highlights the potential role of a staged therapeutic strategy in managing severe hyperbilirubinemia in patients with advanced hepatic dysfunction. The use of corticosteroids and liver-directed radiation therapy facilitated chemotherapy initiation in a patient otherwise deemed ineligible for systemic therapy. While the patient ultimately experienced disease progression, this approach underscores the feasibility of individualized interventions to optimize treatment opportunities. This case demonstrates how staged interventions can create a therapeutic window in patients typically ineligible for chemotherapy. While initial bilirubin reduction allowed systemic therapy, disease progressed, highlighting the limits of current approaches and the need for further research into treatment sequencing and supportive strategies, including liver-directed therapies and emerging systemic agents.