Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5988
Peer-review started: January 14, 2021
First decision: February 10, 2021
Revised: February 15, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: July 26, 2021
Recurrent hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus is a great challenge for oncologists and has a poor prognosis. To date, the safety and efficacy of programmed cell death ligand 1 (PD-L1) inhibitors are still unknown.
A 59-year-old male was identified as having a tumor thrombus in the inferior vena cava 3 years after surgery. The patient underwent a second surgery and adjuvant chemotherapy. However, the level of alpha-fetoprotein was elevated after 2 mo, and lung metastases and mediastinal lymph node metastases were identified. The expression of PD-L1 in HCC and inferior vena cava tumor thrombus tissues was analyzed by immunohistochemistry. Then, the patient received atezolizumab immunotherapy. The level of alpha-fetoprotein dropped to normal, the mediastinal lymph node metastases decreased in size and the lung metastases disappeared after 3 mo of immunotherapy. The patient had no signs of recurrence at 21 mo of follow-up. A 60-year-old male underwent left hepatic tumor resection, inferior vena cava incision and thrombus removal, followed by regular chemotherapy. The patient developed lung and splenic metastases after surgery. Pembrolizumab was used for six courses, and the splenic metastasis shrank, after which splenectomy was performed. The patient continued to receive pembrolizumab for thirteen courses, and the lung metastases showed no progression. A 34-year-old male was diagnosed with liver cancer with inferior vena cava tumor thrombus. The patient underwent right hepatectomy and received tislelizumab for three courses. He is still receiving immunotherapy and in good condition.
Anti-PD-L1 therapy in HCC patients with inferior vena cava tumor thrombus and metastasis is associated with relatively good patient outcomes.
Core Tip: Recurrent hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is a great challenge for oncologists and has a poor prognosis. The safety and efficacy of programmed cell death ligand 1 inhibitors are still unknown. To the best of our knowledge, the first case is the first report of successful treatment of recurrent and metastatic HCC with inferior vena cava tumor thrombus with atezolizumab. We reported two other cases of HCC with IVCTT at the first diagnosis, for which patients were treated with a programmed cell death protein 1 inhibitor after surgery or recurrence, and both patients achieved a good outcome. Anti-programmed cell death ligand 1 therapy in HCC patients with IVCTT and metastasis is associated with relatively good patient outcomes.