Case report: Conversion therapy to permit resection of initially unresectable hepatocellular carcinoma

Abstract

Most patients with hepatocellular carcinoma (HCC) are diagnosed when the disease is already at an advanced stage, so they are not eligible for resection and their prognosis is poor. The combination of transarterial chemoembolization (TACE) with immune checkpoint inhibitors or tyrosine kinase inhibitors can improve unresectable HCC to the point that patients can be treated with surgery. Here we describe two cases of such “conversion therapy”. One patient was a 52-year-old man in Child-Pugh class A with treatment-naive HCC whose 11.3-cm tumor had invaded the middle hepatic vein and right branch of the portal vein. He was treated with TACE plus camrelizumab, and radical resection was performed 3 months later. No evidence of recurrence was observed during 5-month follow-up. The other patient was a 42-year-old man in Child-Pugh class A with HCC involving a 11.4-cm tumor and severe liver cirrhosis. The patient was treated with TACE and lenvatinib, but the embolic effect after one month was unsatisfactory, so the regional treatment was changed to hepatic artery infusion chemotherapy and transcatheter arterial embolization. Radical resection was performed 2 months later, and no recurrence was evident at 1-month follow-up. These cases demonstrate two conversion therapies that may allow patients with initially unresectable HCC to benefit from resection.

Real-world efficiency of combining local interventions with tyrosine kinase inhibitors plus anti- PD-1 blockades in unresectable hepatocellular carcinoma: a single-center retrospective study

“…Furthermore, the combination of HAIC with targeted therapies and/or immunotherapy has demonstrated promising outcomes in terms of overall survival rates 11,12 . Building upon our previous study, we have observed that combining local regional therapies such as TACE or/and HAIC with ICIs or TKIs may be a viable and effective approach for rendering initially unresectable HCC amenable to surgery, including radical surgery, thereby potentially enhancing long-term survival 13 . However, the current body of research on the triple therapy combining local interventions with ICIs and TKIs for patients with advanced unresectable liver cancer remains relatively limited.…”

Importance of optimizing duration of adjuvant immune checkpoint inhibitor therapy to treat postoperative hepatocellular carcinoma after conversion therapy: a case report

“…The alpha-fetoprotein level in our patient’s serum began to rise rapidly after 8 months of adjuvant ICI treatment; after 16 months of treatment, lung metastasis was detected. Our experience highlights the usefulness of elevated alpha-fetoprotein as a marker of tumor recurrence, metastasis, or de novo growth [ 11 ]. Moreover, this case report highlights the need for non-inferiority clinical trials to explore shorter adjuvant ICI therapy to maximize benefit while minimizing risks.…”

Curative surgery for multiple hepatocellular carcinomas after lenvatinib plus transarterial chemoembolization: a case report

“…The effectiveness of treatment for HCC is evaluated by CT and MRI with reference to the modified RECIST [ 8 ]. In addition to imaging evaluation, follow-up of AFP and PIVKA-II concentrations is also reported to be useful for measuring treatment efficacy [ 9 , 10 ]. Shindoh et al .…”