J Liver Cancer.  2019 Mar;19(1):74-78. 10.17998/jlc.19.1.74.

A Case of Achieving Partial Remission with the Combination of Sorafenib and Nivolumab in a Patient with Hepatocellular Carcinoma Showing Disease Progression after Nivolumab Therapy

Affiliations
  • 1Department of Internal Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea. mongmani@hanmail.net
  • 2Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea.

Abstract

Sorafenib is a well-known approved systemic therapeutic agent used in patients with advanced hepatocellular carcinoma (HCC). Regorafenib and nivolumab are approved as second-line therapeutic drugs in patients showing disease progression after sorafenib therapy. However, there is no established third- or fourth-line therapy in patients with progression after regorafenib or nivolumab treatment. Recently, the combination of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICPIs) has been attempted as a first-line treatment strategy in advanced HCC patients based on the hypothesis that combination therapy may overcome resistance in ICPI monotherapy. On the basis of this suggestion, we herein describe the case of an HCC patient demonstrating macrovascular invasion, whereby partial remission was achieved via the combination of sorafenib and nivolumab following disease progression after nivolumab therapy. Further studies on the combination of TKIs and ICPIs are necessary to determine ways to manage HCC patients showing disease progression after ICPI therapy.

Keyword

Hepatocellular carcinoma; Sorafenib; Nivolumab

MeSH Terms

Carcinoma, Hepatocellular*
Disease Progression*
Humans
Protein-Tyrosine Kinases
Protein-Tyrosine Kinases

Figure

  • Figure 1. (A, B) Arterial enhancement of intrahepatic tumors was decreased compared to those observed in previous computed tomography scan (arrows). (C) New onset inferior vena cava tumor thrombosis was also observed (arrows).

  • Figure 2. Simulation and planning image of radiation therapy for inferior vena cava tumor thrombosis.

  • Figure 3. (A, B) Arterial enhancement of intrahepatic tumors was reincreased compared to those observed in previous computed tomography scan (arrows). (C) Progression of inferior vena cava tumor thrombosis was also observed (arrows).

  • Figure 4. (A–C) Marked shrinkage of intrahepatic tumors was observed compared to those observed in previous computed tomography scan (arrows). (D) Shrinkage of inferior vena cava tumor thrombosis was also observed (arrows).

  • Figure 5. Entire clinical course described by tumor markers and received treatments. TACE, transarterial chemoembolization; AFP, alphafetoprotein; PIVKA, protein induced by vitamin K absence.


Reference

1. Cheng AL, Guan Z, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer. 2012; 48:1452–1465.
2. Bruix J, Raoul JL, Sherman M, Mazzaferro V, Bolondi L, Craxi A, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol. 2012; 57:821–829.
3. Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, doubleblind, placebo-controlled, phase 3 trial. Lancet. 2017; 389:56–66.
4. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the american association for the study of liver diseases. Hepatology. 2018; 68:723–750.
5. Hughes PE, Caenepeel S, Wu LC. Targeted therapy and checkpoint immunotherapy combinations for the treatment of cancer. Trends Immunol. 2016; 37:462–476.
6. Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Piscaglia F, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 noninferiority trial. Lancet. 2018; 391:1163–1173.
7. El-Khoueiry AB, Sangro B, Yau T, Crocenzi TS, Kudo M, Hsu C, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017; 389:2492–2502.
8. Kudo M. Combination cancer immunotherapy in hepatoceullar carcinoma. Liver Cancer. 2018; 7:20–27.
Full Text Links
  • JLC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr