J Liver Cancer.  2023 Mar;23(1):213-218. 10.17998/jlc.2023.02.23.

A case of nearly complete response in hepatocellular carcinoma with disseminated lung metastasis by combination therapy of nivolumab and ipilimumab after treatment failure of atezolizumab plus bevacizumab

• Kim HJ
• Hwang SY
• Im JW
• Jeon KJ
• Jeon W

• KMID: 2540834
• DOI: http://doi.org/10.17998/jlc.2023.02.23

Abstract

Recently, the efficacy of immuno-oncologic agents for advanced hepatocellular carcinoma (HCC) has been proven in several trials. In particular, atezolizumab with bevacizumab (AteBeva), as a first-line therapy for advanced HCC, has shown tremendous advances in the IMBrave150 study. However, second or third-line therapy after treatment failure with AteBeva has not been firmly established. Moreover, clinicians have continued their attempts at multidisciplinary treatment that includes other systemic therapy and radiotherapy (RT). Here, we report a case that showed a near complete response (CR) of lung metastasis to nivolumab with ipilimumab therapy after achieving a near CR of intrahepatic tumor using sorafenib and RT in a patient with advanced HCC who had experienced treatment failure of AteBeva.

Keyword

Atezolizumab; Bevacizumab; Radiotherapy; Nivolumab; Ipilimumab

Figure

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  Figure 1. Initial liver magnetic resonance imaging findings. (A) Approximately 21.9 cm of the heterogeneously enhanced mass involving the right lobe of the liver with multifocal arterial enhancement. (B) Delayed washout. (C) Obliteration of the right portal vein (yellow arrows).

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  Figure 2. Chest contrast-enhanced computed tomography. (A) Before AteBeva therapy. (B) After 3 months of AteBeva therapy. (C) After 2 months of sorafenib plus radiation therapy. (D, E) After 3 months of regorafenib therapy. (F, G) After 3 months of nivolumab plus ipilimumab therapy. AteBeva, atezolizumab plus bevacizumab.

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  Figure 3. The clinical course of serum AFP and PIVKA-II levels and the timing of the therapeutic methods. AFP, alpha-fetoprotein; PIVKA-II, protein induced by vitamin K absence-II; Ate+Beva, atezolizumab plus bevacizumab; RT, radiation therapy; Nivo+Ipi, nivolumab plus ipilimumab.

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  Figure 4. Follow-up liver magnetic resonance imaging. (A) After 3 months of AteBeva therapy, slightly increased size (about 22.1 cm) and number of other HCCs in the right lobe of the liver (yellow arrow). (B) After 2 months of sorafenib plus radiation therapy, reduced size by more than 30% of the enormous heterogeneous mass including the right lobe of the liver (yellow arrow). (C) After 3 months of regorafenib therapy, arterial enhancement nearly disappeared and only a single nodular arterial enhancing lesion was slightly increased (yellow arrow). (D) After 3 months of nivolumab plus ipilimumab therapy, the size of the single nodular arterial enhancing lesion was slightly decreased (yellow arrow). AteBeva, atezolizumab plus bevacizumab; HCC, hepatocellular carcinoma.

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  Figure 5. Simultaneous integrated boost radiotherapy and intensity-modulated radiation treatment. Planning target volume 25 Gy with 12 fractions is the required dose for the specified target volumes.

Reference

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