J Liver Cancer.  2020 Mar;20(1):72-77. 10.17998/jlc.20.1.72.

Nivolumab for Advanced Hepatocellular Carcinoma with Multiple Lung Metastases after Sorafenib Failure

• Kim J
• Chang JW
• Park JY

• KMID: 2505845
• DOI: http://doi.org/10.17998/jlc.20.1.72

Abstract

Over the past decade, standard first-line systemic treatment of advanced hepatocellular carcinoma (HCC) has been based on sorafenib, a multi-kinase inhibitor. Regorafenib, another tyrosine kinase inhibitor, is the only second-line therapy that has been globally approved after progression under sorafenib treatment. Recently, immunotherapeutic agents have emerged as promising treatment options in many different malignancies, including advanced HCC. Nivolumab is the first immunotherapy approved by the Food and Drug Administration for use in HCC patients with advanced-stage second-line after sorafenib failure. In this report, a case of advanced HCC with multiple lung metastases in which a complete response and maintained progression-free status was achieved with nivolumab, following the failure of transarterial chemoembolization and sorafenib is presented. We hope this report may help expand the clinical application of second-line treatment.

Keyword

Hepatocellular carcinoma; Lung metastasis; Sorafenib failure; Immunotherapy; Nivolumab

Figure

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  Figure 1. Magnetic resonance imaging findings. Multiple liver masses are seen; 5.8 cm in the dome, 4.1 cm in the S3, and smaller nodules in the S1, 2.4 cm; S7, 0.7 cm & 1.3 cm; and S5, 0.9 cm.

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  Figure 2. The clinical course of serum AFP and PIVKA-II levels and the timing of the therapeutic methods. AFP, α‐fetoprotein; PIVKA-II, protein induced by vitamin K absence-II; TACE, transarterial chemoembolization.

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  Figure 3. Chest radiographs. Follow-up after complete remission achieved, showing no recurrence of the tumor. (A) Before nivolumab therapy. (B) After 4 weeks of nivolumab therapy. (C) After 24 weeks of nivolumab therapy. (D) After 48 weeks of nivolumab therapy. (E) Forty-eight weeks after the end of treatment.

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  Figure 4. Chest contrast‐enhanced computed tomography. (A) Before nivolumab therapy. (B) After 4 weeks of nivolumab therapy. (C) After 12 weeks of nivolumab therapy.

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  Figure 5. Abdomen contrast‐enhanced computed tomography. (A) Before nivolumab therapy. (B) After 4 weeks of nivolumab therapy. (C) After 12 weeks of nivolumab therapy.

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