lenvatinib and Hepatitis-B--Chronic

Hepatocellular carcinoma (HCC) is an aggressive liver tumor that occurs due to chronic liver disease, and it has a high mortality rate and limited treatment options. Immune checkpoint inhibitors have been successfully introduced and used in cancer therapy, among which inhibitors of programmed death ligand-1 (PD-L1) and its receptor programmed death-1 (PD-1) are commonly administered for HCC as combination therapy, including combined anti-angiogenic and immunotherapy combination therapy. We report a case of a primary massive HCC patient with portal hepatic vein tumor thrombus who had a good response to atezolizumab in combination with bevacizumab, following progression of disease on combined immunotherapy with pembrolizumab and lenvatinib. This case demonstrates for the first time that an HCC patient who is resistant to anti-PD-1 antibody immunotherapy can benefit from anti-PD-L1 antibody immunotherapy, providing a potentially promising strategy for the treatment of HCC.

Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; B7-H1 Antigen; Bevacizumab; Carcinoma, Hepatocellular; Drug Substitution; Female; Hepatitis B, Chronic; Humans; Immune Checkpoint Inhibitors; Liver Cirrhosis; Liver Neoplasms; Middle Aged; Phenylurea Compounds; Portal Vein; Programmed Cell Death 1 Receptor; Quinolines; Salvage Therapy; Tomography, X-Ray Computed; Venous Thrombosis

Advanced intrahepatic cholangiocarcinoma (iCCA) is not suitable for surgical treatment. Guided by the concept of precision medicine, preoperative systematic treatment may reshape the clinical outcomes of advanced intrahepatic cholangiocarcinoma patients. We describe the case of a 38-year-old female who has been diagnosed with stage IV intrahepatic cholangiocarcinoma with a high tumor mutational burden and positively programmed death-ligand 1 (PD-L1) expression. The patient was treated with programmed cell death 1 (PD-1) inhibitors combined with tyrosine kinase inhibitors (TKIs). After 7 cycles of combination therapy, she underwent radical resection and no tumor cells were found in the postoperative histopathological examination. In addition, the patient's survival time had reached 25 months, as of August 2021. To date, this is the first case of successful radical resection after combined immunotherapy with TKIs for advanced PD-L1-positive intrahepatic cholangiocarcinoma with a high tumor mutational burden (TMB). The case provides a new approach to the treatment of advanced intrahepatic cholangiocarcinoma.

Topics: Adult; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; B7-H1 Antigen; Bile Duct Neoplasms; Chemotherapy, Adjuvant; Cholangiocarcinoma; Female; Hepatitis B, Chronic; Humans; Immune Checkpoint Inhibitors; Neoadjuvant Therapy; Phenylurea Compounds; Protein Kinase Inhibitors; Quinolines

Topics: Aged; Carcinoma, Hepatocellular; Cardiac Catheterization; Endothelin Receptor Antagonists; Hepatitis B, Chronic; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Neoplasms; Male; Medication Therapy Management; Phenylurea Compounds; Protein Kinase Inhibitors; Protein-Tyrosine Kinases; Pulmonary Arterial Hypertension; Pyrimidines; Quinolines; Sulfonamides; Tomography, X-Ray Computed; Treatment Outcome