Abstract
BackgroundThe majority of patients diagnosed with hepatocellular carcinoma (HCC) have advanced diseases and many are not eligible for curative therapies.Case presentationWe report a rare case of HCC from a patient who had a complete response (CR) with the use of combination of Lenvatinib and Pembrolizumab. A 63-year-old man presented at the hospital with serious abdominal pain and was found to have a mass with heterogeneous enhancement and with hemorrhage in segment III of the liver after the examination of abdominal computerized tomography (CT) scan. The patient’s history of viral hepatitis B infection, liver cirrhosis and the ɑ-fetoprotein (AFP) level of 14,429.3 ng/ml supported the clinical diagnosis of HCC and laboratory results demonstrated liver function damage status (Child-Pugh class B, Score 8). The patient first received hepatic arterial embolization treatment on 28th November 2017. At this stage supportive care was recommended for poor liver function. In February 2018, combined immunotherapy of Pembrolizumab (2 mg/kg, q3w) and Lenvatinib (8 mg–4 mg, qd) were performed. Nine months following the treatment he had a CR and now, 22 months since the initial treatment, there is no clinical evidence of disease progression. The current overall survival is 22 months.ConclusionsHCC is a potentially lethal malignant tumor and the combination of immunotherapy plus anti-angiogenic inhibitors shows promising outcome for advanced diseases.
Highlights
The majority of patients diagnosed with hepatocellular carcinoma (HCC) have advanced diseases and many are not eligible for curative therapies.Case presentation: We report a rare case of Hepatocellular carcinoma (HCC) from a patient who had a complete response (CR) with the use of combination of Lenvatinib and Pembrolizumab
The first line options for unresectable HCC (uHCC) include Sorafenib and Lenvatinib, and second line options are formed by Regorafenib and Cabozantinib
To evaluate clinical efficacy of the combination rationale including immune checkpoint inhibitors and multikinase inhibitors, we report a case of HCC with poor liver function in the setting of cirrhosis from hepatitis B virus (HBV) infection responding dramatically to the combination treatment of Pembrolizumab and Lenvatinib after initial hepatic arterial embolization (HAE) and we hope to explore further study for anti-programmed death receptor-1 (PD-1) therapy and multikinase targeted therapy combination for HCC treatment in the future
Summary
Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer death in the United States with a 5-year survival rate of 18% for all stages [1] and its incidence rate is rising faster than that of any other cancer in both men and women [2]. To evaluate clinical efficacy of the combination rationale including immune checkpoint inhibitors and multikinase inhibitors, we report a case of HCC with poor liver function in the setting of cirrhosis from HBV infection responding dramatically to the combination treatment of Pembrolizumab and Lenvatinib after initial hepatic arterial embolization (HAE) and we hope to explore further study for anti-PD-1 therapy and multikinase targeted therapy combination for HCC treatment in the future. The patient first received HAE and discharged with an HBV DNA level below 30 IU/ml after antiviral treatment with entecavir He had radiographic progression 2 months later (Fig. 2a) with poor liver function (Child-Pugh class B 7) (Table 1). For lack of an available clinical trial, the patient was prescribed off-label immunotherapy based on the phase I/II data mentioned above (KEYNOTE224) He was recommended to take Pembrolizumab 100 mg (2 mg/kg, q3w) on Feb. 8th 2018, which was well tolerated. ORR objective response rate, AE adverse event, DLT dose limited toxicity, LEN Lenvatinib, PEM Pembrolizumab, MTD maximum tolerance dose, DOR duration of response, dMMR mismatch repair deficient, PFS progression-free survival, OS overall survival, CR complete response, PD-L1 programmed cell death ligand 1, TMB tumor mutation burden
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