Five-Year Complete Remission in Super-Giant Hepatocellular Carcinoma with Hepatectomy Followed by Sorafenib Plus Camrelizumab: A Case Report

Zheng X, Sun L, Jin W, Liu H, Song W, Xu H, Wu J, Wang X, Gou C and Ding H

Integrated Traditional Chinese and Western Medicine Center, Beijing Youan Hospital, Capital Medical University, China
Department of Surgery, Beijing Youan Hospital, Capital Medical University, China
Institute for Research in Biomedicine, Università della Svizzera italiana, Switzerland
Institute of Microbiology, Eidgenössische Technische Hochschule (ETH) Zürich, Switzerland
Department of Pathology, Beijing Youan Hospital, Capital Medical University, China
Department of Radiology, Beijing Youan Hospital, Capital Medical University, China
Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, China

^*Correspondance to: Huiguo Ding 

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Abstract:

Background: Cirrhotic patients with super-giant Hepatocellular Carcinoma (HCC), accompanied by portal vein invasion, generally face a poor prognosis. Although multitargeted Tyrosine Kinase Inhibitors (TKIs) and Immune Checkpoint Inhibitors (ICIs) present a promising treatment option, achieving long-term Complete Remission (CR) in a cirrhotic patient with super-giant HCC is rare. Case Summary: A 40-year-old male with compensated hepatitis B-related cirrhosis was diagnosed with HCC, classified as BCLC stage C. Enhanced CT imaging revealed a 152 mm × 171 mm tumor in the right lobe of the liver, invading the right branches of the portal vein and hepatic vein. He had normal liver function tests, platelet count, International Normalized Ratio (INR), ICG-15, and liver stiffness measurements. The patient underwent a successful hepatectomy beyond current indications on July 2019. Unfortunately, HCC recurrence with lung metastases and a portal vein tumor thrombus was detected in December 2019. He promptly began treatment with TKI (Sorafenib, 200 mg twice daily) and ICI (Camrelizumab, a humanized anti-PD-1 monoclonal antibody, 200 mg every 3 weeks). On May 2020, the patient had achieved CR confirmed by enhanced CT and tumor markers. The dosage of Camrelizumab was adjusted to 200 mg every 12 weeks since June 2021 to March 2024. Despite effective control of the HCC, the patient experienced episodes of gastrointestinal bleeding, attributed to esophagogastric varices confirmed by gastroscopy, and treated with endoscopic variceal band ligation and cyanoacrylate injection. Remarkably, no further tumor recurrence and variceal bleeding were observed during 5-year follow-up every 6 months. Until now, the patient has survived for 5 years with complete and durable remission. Conclusion: The combination of TKIs and ICs is a potentially effectiveness and feasibility for super-giant HCC patients with portal vein invasion after hepatectomy beyond current surgical indications. However, extensive using of TKIs plus ICIs raise two critical issues: (1) the need for effective endoscopic screening varices and management of portal hypertension in HCC patients, (2) the determination of optimal treatment duration as well as safe discontinuation of TKIs and ICIs in long-term CR HCC patients.

Keywords:

Hepatectomy; Sorafenib; Camrelizumab; Super-giant hepatocellular carcinoma; Complete remission

Cite the Article:

Zheng X, Sun L, Jin W, Liu H, Song W, Xu H, et al. Five-Year Complete Remission in Super-Giant Hepatocellular Carcinoma with Hepatectomy Followed by Sorafenib Plus Camrelizumab: A Case Report. Clin Oncol. 2024;9:2099..