Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2023; 11(27): 6558-6564
Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6558
Triplet regimen as a novel modality for advanced unresectable hepatocellular carcinoma: A case report and review of literature
Ying Zhao, Guo-Sheng He, Gong Li
Ying Zhao, Guo-Sheng He, Gong Li, Department of Radiation Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Author contributions: Zhao Y analyzed the data and wrote the manuscript; He GS collected the data; Li G edited and approved the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gong Li, MD, Doctor, Researcher, Department of Radiation Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. dr_gongli@163.com
Received: June 6, 2023
Peer-review started: June 6, 2023
First decision: August 8, 2023
Revised: August 22, 2023
Accepted: August 31, 2023
Article in press: August 31, 2023
Published online: September 26, 2023
Abstract
BACKGROUND

Portal vein tumor thrombus (PVTT) is a common complication, accounting for 44%-62.2% of Hepatocellular carcinoma (HCC), and often indicates the poor prognosis. There is no global consensus for the treatment of unresectable HCC with PVTT. In the present case, we reported a novel strategy of radiotherapy-antiangiogenesis-immune checkpoint blockade combination, which showed better response and prolonged survival.

CASE SUMMARY

A 51-year-old male diagnosed with HCC (Child-Pugh class A), chronic hepatitis B virus infection and Cheng’s type III PVTT, was given radiotherapy to part of the lesion plus targeted therapy as the first-line therapy, and achieved partial remission. After radiotherapy, lenvatinib plus pembrolizumab was used as maintenance therapy, and complete remission was achieved. The patient remains alive 46 months after the diagnosis of the HCC with PVTT.

CONCLUSION

This case of unresectable HCC patient with PVTT treated by radiation-lenvatinib-pembrolizumab combination therapy shows apparent clinical efficacy, which demonstrates that local radiotherapy plus antiangiogenesis and immune checkpoint blockad could also benefit patients with advanced HCC.

Keywords: Hepatocellular carcinoma, Portal vein tumor thrombosis, Radiotherapy, Combination therapy, RACIB, Case report

Core Tip: Primary hepatoma patients with inferior vena cava tumor thrombus and portal vein tumor thrombus are rare, and both are inferior prognostic factors for such patients. There are no worldwide consensuses or guidelines on the diagnosis and treatment of hepatocellular carcinoma patients with macrovascular invasion. We used a new treatment model for this patient: radiotherapy combined with target therapy followed by immune maintenance therapy; and achieved extended survival.