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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Anti-programmed cell death ligand 1-based immunotherapy in recurrent hepatocellular carcinoma with inferior vena cava tumor thrombus and metastasis: Three case reports
Shao-Ru Liu, Qing Yan, Hao-Ming Lin, Guang-Zi Shi, Yi Cao, Hong Zeng, Chao Liu, Rui Zhang
Shao-Ru Liu, Qing Yan, Hao-Ming Lin, Chao Liu, Rui Zhang, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510288, Guangdong Province, China
Guang-Zi Shi, Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Yi Cao, Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Hong Zeng, Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Author contributions: Zhang R and Liu C contributed conception and design of this article; Liu SR, Yan Q and Lin HM wrote the initial version of the manuscript; Cao Y helped provide the clinical data of patients; Shi GZ and Zeng H provided and analyzed the imaging of the patients; all authors have contributed to the revision of the manuscript and approved the submitted version.
Supported by The Special Research Foundation of the National Nature Science Foundation of China, No. 81972262 and No. 81972255; The Guangdong Basic and Applied Basic Research Foundation, No. 2018A030313645, No. 2020A1515010117 and No. 2016A030313840; Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology, No. [2013]163; the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, No. KLB09001; Guangdong Science and Technology Department, No. 2015B050501004; Guangdong Science and Technology Department, No. 2017B030314026; and Sun Yat-sen University Clinical Research 5010 Program, No. 2018008.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: This article is written in compliance with 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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rui Zhang, PhD, Doctor, Professor, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 33 Yingfeng Road, Haizhu District, Guangzhou 510288, Guangdong Province, China. zhangr95@mail.sysu.edu.cn
Received: January 14, 2021
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
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
