Multimodal Combination Regimen for a Patient with Advanced Huge Hepatocellular Carcinoma: a Case Report

Overview

Journal Transl Gastroenterol Hepatol

Publisher AME Publishing Company

Specialty Gastroenterology

Date 2025 Feb 13

PMID 39944577

Authors

Shan Li

Zhen-Feng Zhou

Hao-Jian Long

Jia-Xin Yin

Hui-Zhong Wang

Jian-Fu Zhao

Affiliations

Soon will be listed here.

Abstract

Background: Hepatocellular carcinoma (HCC) is a highly malignant tumor of the digestive system with a poor prognosis. Huge HCC, a subtype characterized by tumors measuring at least 10 cm in diameter, often presents with macrovascular invasion, satellite nodules, metastases, and other aggressive characteristics, posing significant challenges for treatment. The era of combined targeted therapy and immunotherapy has brought new hope to patients with advanced HCC. The development of innovative combination medication regimens for HCC is a current area of intense clinical research interest. We are trying to explore new combination therapies based on target-immunity combination therapy in the hope of better-benefiting patients with advanced huge HCC.

Case Description: We present a patient with Barcelona Clinical Liver Cancer Stage C huge HCC who was treated with combined targeted therapy and immunotherapy as the primary therapeutic regimen, supplemented with tegafur long-term metronomic chemotherapy, as well as specialized adjuvant therapy such as thymosin, bisphosphonates, antiviral medication, and vitamin C supplementation. The tumor size was significantly reduced and microwave ablation was performed, after which, the patient was kept on the combination regimen, resulting in a partial response (PR), and maintaining PR without disease progression for 32 months.

Conclusions: The combination regimen may enhance advanced huge HCC treatment and provide a new multimodal drug strategy for HCC.

References

Vogl T, Nour-Eldin N, Hammerstingl R, Panahi B, Naguib N . Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms - Review Article. Rofo. 2017; 189(11):1055-1066. DOI: 10.1055/s-0043-117410. View

Dong T, Wang L, Li M, Yin C, Li Y, Nie F . Clinical Results, Risk Factors, and Future Directions of Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma. J Hepatocell Carcinoma. 2023; 10:733-743. PMC: 10198179. DOI: 10.2147/JHC.S409011. View

Wang S, Huang M, Chen M, Sun Z, Jiao Y, Ye G . Zoledronic acid and thymosin α1 elicit antitumor immunity against prostate cancer by enhancing tumor inflammation and cytotoxic T cells. J Immunother Cancer. 2023; 11(6). PMC: 10277537. DOI: 10.1136/jitc-2022-006381. View

Motz G, Santoro S, Wang L, Garrabrant T, Lastra R, Hagemann I . Tumor endothelium FasL establishes a selective immune barrier promoting tolerance in tumors. Nat Med. 2014; 20(6):607-15. PMC: 4060245. DOI: 10.1038/nm.3541. View

Yi C, Chen L, Lin Z, Liu L, Shao W, Zhang R . Lenvatinib Targets FGF Receptor 4 to Enhance Antitumor Immune Response of Anti-Programmed Cell Death-1 in HCC. Hepatology. 2021; 74(5):2544-2560. DOI: 10.1002/hep.31921. View

Hui F, Xu C, Xu X, Chen J, Geng H, Yang C . What Is the Most Suitable Agent Combined With Apatinib for Transarterial Chemoembolization Treatment in Advanced Hepatocellular Carcinoma Patients? A Systematic Review and Network Meta-analysis. Front Oncol. 2022; 12:887332. PMC: 9174538. DOI: 10.3389/fonc.2022.887332. View

Camerini R, Garaci E . Historical review of thymosin α 1 in infectious diseases. Expert Opin Biol Ther. 2015; 15 Suppl 1:S117-27. DOI: 10.1517/14712598.2015.1033393. View

Gunasekaran V, Elangovan K, Niranjali Devaraj S . Targeting hepatocellular carcinoma with piperine by radical-mediated mitochondrial pathway of apoptosis: An in vitro and in vivo study. Food Chem Toxicol. 2017; 105:106-118. DOI: 10.1016/j.fct.2017.03.029. View

Qin S, Chan S, Gu S, Bai Y, Ren Z, Lin X . Camrelizumab plus rivoceranib versus sorafenib as first-line therapy for unresectable hepatocellular carcinoma (CARES-310): a randomised, open-label, international phase 3 study. Lancet. 2023; 402(10408):1133-1146. DOI: 10.1016/S0140-6736(23)00961-3. View

10.

Yang Y, Wang C, Sun H, Jiang Z, Zhang Y, Pan Z . Apatinib prevents natural killer cell dysfunction to enhance the efficacy of anti-PD-1 immunotherapy in hepatocellular carcinoma. Cancer Gene Ther. 2020; 28(1-2):89-97. DOI: 10.1038/s41417-020-0186-7. View

11.

Kloeckner R, Galle P, Bruix J . Local and Regional Therapies for Hepatocellular Carcinoma. Hepatology. 2020; 73 Suppl 1:137-149. DOI: 10.1002/hep.31424. View

12.

Schmiderer A, Zoller H, Niederreiter M, Effenberger M, Oberhuber G, Krendl F . Liver Transplantation after Successful Downstaging of a Locally Advanced Hepatocellular Carcinoma with Systemic Therapy. Dig Dis. 2023; 41(4):641-644. DOI: 10.1159/000529023. View

13.

Pinato D, Guerra N, Fessas P, Murphy R, Mineo T, Mauri F . Immune-based therapies for hepatocellular carcinoma. Oncogene. 2020; 39(18):3620-3637. PMC: 7190571. DOI: 10.1038/s41388-020-1249-9. View

14.

Costantini C, Bellet M, Pariano M, Renga G, Stincardini C, Goldstein A . A Reappraisal of Thymosin Alpha1 in Cancer Therapy. Front Oncol. 2019; 9:873. PMC: 6742685. DOI: 10.3389/fonc.2019.00873. View

15.

Qin S, Bai Y, Lim H, Thongprasert S, Chao Y, Fan J . Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia. J Clin Oncol. 2013; 31(28):3501-8. DOI: 10.1200/JCO.2012.44.5643. View

16.

Cheng A, Qin S, Ikeda M, Galle P, Ducreux M, Kim T . Updated efficacy and safety data from IMbrave150: Atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma. J Hepatol. 2021; 76(4):862-873. DOI: 10.1016/j.jhep.2021.11.030. View

17.

Bray F, Laversanne M, Sung H, Ferlay J, Siegel R, Soerjomataram I . Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74(3):229-263. DOI: 10.3322/caac.21834. View

18.

Du X, Chen D, Lin Z, Dong Z, Lu Y, Liu L . Efficacy of apatinib in advanced hepatocellular carcinoma with lung metastasis: a retrospective, multicenter study. J BUON. 2019; 24(5):1956-1963. View

19.

Wakayama K, Kamiyama T, Yokoo H, Orimo T, Shimada S, Einama T . Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection. J Surg Oncol. 2017; 115(3):324-329. DOI: 10.1002/jso.24501. View

20.

Cappuyns S, Corbett V, Yarchoan M, Finn R, Llovet J . Critical Appraisal of Guideline Recommendations on Systemic Therapies for Advanced Hepatocellular Carcinoma: A Review. JAMA Oncol. 2023; 10(3):395-404. PMC: 10837331. DOI: 10.1001/jamaoncol.2023.2677. View