Multimodal combination regimen for a patient with advanced huge hepatocellular carcinoma: a case report

Abstract

Background: Hepatocellular carcinoma (HCC) is a highly malignant tumor of the digestive system with a poor prognosis. Huge HCC, a subtype characterized by tumors measuring at least 10 cm in diameter, often presents with macrovascular invasion, satellite nodules, metastases, and other aggressive characteristics, posing significant challenges for treatment. The era of combined targeted therapy and immunotherapy has brought new hope to patients with advanced HCC. The development of innovative combination medication regimens for HCC is a current area of intense clinical research interest. We are trying to explore new combination therapies based on target-immunity combination therapy in the hope of better-benefiting patients with advanced huge HCC.

Case description: We present a patient with Barcelona Clinical Liver Cancer Stage C huge HCC who was treated with combined targeted therapy and immunotherapy as the primary therapeutic regimen, supplemented with tegafur long-term metronomic chemotherapy, as well as specialized adjuvant therapy such as thymosin, bisphosphonates, antiviral medication, and vitamin C supplementation. The tumor size was significantly reduced and microwave ablation was performed, after which, the patient was kept on the combination regimen, resulting in a partial response (PR), and maintaining PR without disease progression for 32 months.

Conclusions: The combination regimen may enhance advanced huge HCC treatment and provide a new multimodal drug strategy for HCC.

Keywords: Huge hepatocellular carcinoma (huge HCC); case report; immunotherapy; multimodal combination regimen; targeted therapy.

Figure 1

MRI scan image showing the progress of HCC. (A) Baseline condition of the tumor before treatment. Primary huge lesion of HCC (red arrows). (B) The tumor condition after two cycles of treatment. A notable reduction in the size of the HCC (red arrows). (C) The tumor condition after eight cycles of treatment. The tumor lesion has continued to decrease in size (red arrows) and has achieved PR. (D) Post-operative situation of MWA. The tumor focus was reduced in size compared to its previous dimensions (red arrows). (E) The last follow-up imaging assessment. The size of the tumor lesion in the right lobe of the liver has remained stable (red arrows). MRI, magnetic resonance imaging; HCC, hepatocellular carcinoma; PR, partial response; MWA, microwave ablation.

Figure 2

Alterations in maximum tumor diameter during treatment.

Figure 3

Alterations in serum AFP levels during treatment. AFP, α-fetoprotein; MWA, microwave ablation.

Figure 4

Alterations in AST/ALT level during treatment. AST, aspartate aminotransferase; ALT, alanine aminotransferase.

Figure 5

The complete treatment procedure. HCC, hepatocellular carcinoma; PD-1, programmed cell death protein-1; Bev, bevacizumab; S-1, tegafur; MWA, microwave ablation; m-Recist, modified Recist; Recist, Response Evaluation Criteria in Solid Tumors; PR, partial response.