Metastatic Hepatocellular Carcinoma Responsive to Pembrolizumab

Abstract

Hepatocellular carcinoma (HCC) is an aggressive liver tumor that occurs with chronic liver disease. Surgical resection is the mainstay of therapy for localized disease whereas therapeutic options for advanced disease are limited. The innovative blockade of immune checkpoints with targeted immunotherapies, such as monoclonal antibodies against programmed death receptor 1 (PD-1), have shown promise in the treatment of solid malignancies. The PD-1 inhibiting antibodies, nivolumab and pembrolizumab prolonged overall survival in randomized trials in metastatic melanoma and advanced non-small cell lung cancer. This is a report of a 75-year-old male patient with metastatic HCC who was initially treated with the standard of therapy sorafenib. After failure of sorafenib therapy, pembrolizumab was started. There was a dramatic response to pembrolizumab with decrease in tumor size and drop in alfa fetoprotein. To the best of our knowledge, this is the first case report of metastatic HCC responsive to pembrolizumab after failure of sorafenib.

A Complete Pathological Response to Pembrolizumab following ex vivo Liver Resection in a Patient with Colorectal Liver Metastases

“…A patient with a sporadic mismatch-repair-deficient mCRC with abdominal disease had shrinkage of the peritoneal tumor mass to 25% of the original tumor volume, return to normal tumor markers, and clinical performance improvement [19]. Another report of a patient with metastatic hepatocellular carcinoma who did not respond to traditional chemotherapy also had a significant improvement in tumor markers and shrinkage of tumor burden with anti-PD-1 treatment [20]. Sehdev et al [21] described a patient who followed a very similar course as ours.…”

Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: Opportunities and Challenges

“…A trial of tremelimumab in HCC treatment was conducted in 2013 but resulted in more adverse events than were caused by anti‐PD‐1 antibodies . In 2016, Truong et al reported a case of metastatic HCC that responded dramatically to pembrolizumab after the failure of sorafenib, in contrast with the above study. Since the CheckMate 040 trial, a phase III trial (CheckMate 459) has been initiated as indicated above, with pembrolizumab in patients who did not respond to sorafenib in a second‐line setting, including a phase II trial (KEYNOTE‐224, one arm) and a phase III trial (KEYNOTE‐240, pembrolizumab vs. placebo).…”

Vollständiges pathologisches Ansprechen auf Pembrolizumab nach Ex-vivo-Leberresektion bei einer Patientin mit Lebermetastasen eines kolorektalen Karzinoms

“…Ein Patient mit sporadischem MMR-defizitärem mCRC mit abdominalem Befall zeigte eine Verkleinerung der peritonealen Tumormasse auf 25% des ursprünglichen Volumens, eine Normalisierung der Tumormarker und klinisch eine Leistungsverbesserung [19]. Ein anderer Patient mit metastasierendem hepatozellulärem Karzinom, der nicht auf konventionelle Chemotherapie angesprochen hatte, zeigte ebenfalls eine signifikante Verbesserung der Tumormarker und eine Reduktion der Tumorlast unter der Anti-PD-1-Therapie [20]. Sehdev et al [21] beschreiben einen Patienten mit ganz ähnlichem Verlauf wie in unserem Fall.…”