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Song WJ, Xu J, Nie Y, Li WM, Li JP, Yang L, Wei MQ, Tao KS. Conversion therapy of a giant hepatocellular carcinoma with portal vein thrombus and inferior vena cava thrombus: A case report and review of literature. World J Clin Cases 2024; 12:2847-2855. [DOI: 10.12998/wjcc.v12.i16.2847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/26/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The prognosis of hepatocellular carcinoma (HCC) combined with portal and hepatic vein cancerous thrombosis is poor, for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC, with a median survival time of only about 2.7-6 months. In this case report, we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.
CASE SUMMARY In our center, a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization (TACE), radiotherapy, targeted therapy and immunotherapy, and was continuously given Epimedium soft capsules for oral regulation. After 7 months of conversion therapy, the patient's tumor shrank and the tumor thrombus subsided significantly. The pathology of surgical resection was in complete remission, and there was no progression in the postoperative follow-up for 7 months, which provided a basis for the future strategy of combined conversion therapy.
CONCLUSION In this case, atezolizumab, bevacizumab, icaritin soft capsules combined with radiotherapy and TACE had a good effect. For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus, adopting a high-intensity, multimodal proactive strategy under the guidance of multidisciplinary team (MDT) is an important attempt to break through the current treatment dilemma.
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Affiliation(s)
- Wen-Jie Song
- Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Jian Xu
- Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Ye Nie
- Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Wei-Min Li
- Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Jian-Ping Li
- Department of Radiotherapy, The First Affiliated Hospital of the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
| | - Li Yang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Xijing Hospital, Air Force Medical University, Xi'an 710000, Shaanxi Province, China
| | - Meng-Qi Wei
- Department of Radiology, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Kai-Shan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
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Qu WF, Ding ZB, Qu XD, Tang Z, Zhu GQ, Fu XT, Zhang ZH, Zhang X, Huang A, Tang M, Tian MX, Jiang XF, Huang R, Tao CY, Fang Y, Gao J, Wu XL, Zhou J, Fan J, Liu WR, Shi YH. Conversion therapy for initially unresectable hepatocellular carcinoma using a combination of toripalimab, lenvatinib plus TACE: real-world study. BJS Open 2022; 6:6706648. [PMID: 36125345 PMCID: PMC9499852 DOI: 10.1093/bjsopen/zrac114] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/12/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Combination conversion therapies afforded curative surgery chance for initially unresectable hepatocellular carcinoma (uHCC). This study aimed to evaluate the conversion rate and clinical outcomes of a first-line conversion regimen of lenvatinib combined with transarterial chemoembolization (TACE) plus immunotherapy for initial uHCC by interpreting real-world data. Methods Conversion therapy data of patients with uHCC from November 2018 to January 2021 were analysed. The regimens included triple combination therapy (t-CT: lenvatinib, TACE, plus toripalimab) and dual combination therapy (d-CT: lenvatinib plus TACE). Another study population diagnosed with hepatocellular carcinoma of macrovascular invasion disease were included as the upfront surgery cohort. Treatment responses and conversion rate were primary outcomes. Survival and adverse events were analysed. Results Fifty-one patients receiving t-CT (n = 30) and d-CT (n = 21) were enrolled. Higher overall response rates (76.7 per cent versus 47.6 per cent, P = 0.042) and disease control rates (90.0 per cent versus 57.1 per cent, P = 0.042) were observed via t-CT than d-CT. Both median overall survival and event-free survival were not reached in the t-CT cohort. A higher rate of curative conversion resection was achieved through t-CT than d-CT (50.0 per cent versus 19.0 per cent, P = 0.039). The disease-free survival of patients undergoing conversion resection in the t-CT cohort (n = 15) was higher than that in the upfront surgery cohort (n = 68, P = 0.039). Both t-CT and d-CT regimens were tolerable. Conclusions Better treatment responses and conversion rate for patients with uHCC were obtained with first-line t-CT. Neoadjuvant t-CT before surgery should be recommended for patients with macrovascular invasion.
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Affiliation(s)
- Wei-Feng Qu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Zhen-Bin Ding
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Xu-Dong Qu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Zheng Tang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Gui-Qi Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Xiu-Tao Fu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Zi-Han Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Xin Zhang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Ao Huang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Min Tang
- Department of Radiology, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Meng-Xin Tian
- Department of General Surgery, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Xi-Fei Jiang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Run Huang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Chen-Yang Tao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Yuan Fang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Jun Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Xiao-Ling Wu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
| | - Jian Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
- Department of Radiology, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
- Department of Radiology, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Wei-Ren Liu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai , China
| | - Ying-Hong Shi
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, and Research Unit of Bench and Clinic Research for Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences , Shanghai , China
- Shanghai Key Laboratory of Organ Transplantation , Shanghai , China
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai , China
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