Case Report: Clinical Responses to Tislelizumab as a First-Line Therapy for Primary Hepatocellular Carcinoma With B-Cell Indolent Lymphoma

Abstract

BackgroundAs an emerging therapy with a promising efficacy, immunotherapy has been widely used in the treatment of solid tumors and hematologic malignancies. This clinical study compares the efficacy of tislelizumab, a domestic immune checkpoint inhibitor (ICI), to that of sorafenib when used as a first-line therapeutic option in hepatocellular carcinoma (HCC), and the concurrence of HCC and non-Hodgkin’s lymphoma (NHL) is rare, especially in the treatment of ICIs.Case presentationA 61-year-old patient presenting with primary HCC and indolent B-cell lymphoma had a partial clinical response to tislelizumab for his primary HCC. Besides, we described a phenomenon of pseudo-progression and delayed diagnosis of his lymphoma during a long course of treatment.ConclusionTislelizumab, an immunotherapeutic option with a favorable efficacy and toxicity, can be used to manage double primary tumors. However, studies should aim to elucidate the probable mechanisms of this therapy. Pseudo-progression and separation remission make the treatment of double primary tumors even more challenging, which calls for additional caution in patients undergoing immunotherapy to avoid misdiagnosis and, therefore, begin early appropriate interventions.

Rationale and design of a prospective, multicenter, phase II clinical trial of safety and efficacy evaluation of long course neoadjuvant chemoradiotherapy plus tislelizumab followed by total mesorectal excision for locally advanced rectal cancer (NCRT-PD1-LARC trial)

“…Nevertheless, the proportion of dMMR in LARC is about 15% and the effectiveness of PD-1/PD-L1 inhibitors in pMMR LARC is still indeterminate. Tislelizumab is an anti-PD1 monoclonal antibody which was specifically engineered to minimize Fcγ receptor binding on macrophages, for achieving abrogating antibody-dependent phagocytosis which is identified as a reason of T-cell clearance and further potential resistance to anti-PD1 therapy [ 36 , 37 ]. Furthermore, tislelizumab has been approved for treating recurrent/refractory classical Hodgkin lymphoma and locally advanced/metastatic urothelial carcinoma in China.…”

Unraveling the Complexities of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma

“…PsP in HCC can manifest in various ways, such as the growth of primary or metastatic lesions, an increase in tumor markers, or persistent immune cell infiltration. 115,116 Studies have described characteristic features of PsP, including an initial increase in target lesion size and alpha fetoprotein (AFP) levels during immune response assessments, followed by subsequent tumor shrinkage. 109,116,117 AFP levels serve as a prognostic predictor accurately reflecting the therapeutic efficacy of ICIs.…”

“…115,116 Studies have described characteristic features of PsP, including an initial increase in target lesion size and alpha fetoprotein (AFP) levels during immune response assessments, followed by subsequent tumor shrinkage. 109,116,117 AFP levels serve as a prognostic predictor accurately reflecting the therapeutic efficacy of ICIs. 118 AFP levels below 400 g/L have been associated with better survival outcomes.…”

Use of multikinase inhibitors/lenvatinib in patients with synchronous/metachronous cancers coinciding with radioactive‐resistant differentiated thyroid cancer

“…To add more complexity to this picture, the use of an MKI even when it is established as standard therapy for a given condition, could be detrimental. 61 , 62 For example, imatinib has been associated with increased risk for hematologic malignancies (mostly chronic myeloid leukemia) and worse outcomes than expected in patients with SPCs. 63 , 64 , 65 SPCs have also been described in patients with advanced DTC treated with sorafenib.…”