J Liver Cancer.  2022 Mar;22(1):75-83. 10.17998/jlc.2022.03.04.

Multidisciplinary treatment with immune checkpoint inhibitors for advanced stage hepatocellular carcinoma

• Lee A
• Lee J
• Yang H
• Sung SY
• Jeon CH
• Kim SH
• Choi MH
• Lee YJ
• Chun HJ
• Bae SH

• KMID: 2528300
• DOI: http://doi.org/10.17998/jlc.2022.03.04

Abstract

Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.

Keyword

Hepatocellular carcinoma; Atezolizumab; Bevacizumab; Multidisciplinary treatment; Case report

Figure

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  Figure 1 Initial liver dynamic computed tomography of the first patient showed approximately 12.8 cm of the heterogeneously enhanced mass in the arterial phase (A) with washout in the delayed phase (B). The main and left portal vein tumor thrombosis was observed in the portal phase (C). The boundaries of the tumor and PVTT are indicated with arrowheads (A–C).

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  Figure 2 Follow-up gadoxetic acid-enhanced liver magnetic resonance imaging after 8 cycles of atezolizumab plus bevacizumab, hepatic arterial infusion chemotherapy and radiation therapy showed decreased size of the hepatocellular carcinoma without viable area in the arterial and delayed phase (A, B). No extension of portal vein tumor thrombosis was observed in the portal phase (C). The boundaries of the tumor and PVTT are indicated with arrowheads (A–C).

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  Figure 3 Changes in tumor marker levels in the first patient. AFP, alpha-fetoprotein; PIVKA-II, prothrombin-induced by vitamin K absence or antagonist-II; AteBeva, atezolizumab plus bevacizumab; HAIC, hepatic arterial infusion chemotherapy; RT, radiation therapy.

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  Figure 4 Initial liver dynamic computed tomography of the second patient showed approximately 23.5×13.7 cm of the heterogeneously enhanced mass in the arterial phase (A) with washout in the delayed phase (B). Coronal section in the portal phase (C). The boundaries of the tumor are indicated with arrowheads (A–C). Multiple lung metastases were observed in both lung fields (D–F, marked with arrows).

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  Figure 5 Follow-up liver dynamic computed tomography after the 3rd cycle of transarterial chemoembolization and the 5th cycle of hepatic arterial infusion chemotherapy showed decreased size of hepatocellular carcinoma in the arterial and delayed phase with viable area (A, B). Coronal section in the portal phase (C). Progression of lung metastases was observed in both lung fields (D–F, marked with arrows).

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  Figure 6 Follow-up liver dynamic computed tomography after treatment with lenvatinib for 3 months showed decreased size of hepatocellular carcinoma in the arterial and delayed phase without viable area (A, B). Coronal section in the portal phase (C). Changes in tumor marker levels. Y-axis is in log scale (D). AFP, alpha-fetoprotein; PIVKA-II, prothrombin-induced by vitamin K absence or antagonist-II; HAIC, hepatic arterial infusion chemotherapy; AteBeva, atezolizumab plus bevacizumab; TACE, transarterial chemoembolization.

Reference

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