Liu Zhen, Meng Ying, Xiao Wenming, Wang Huijun, Sun Li, Fu Zheng, Xiong Xuejie, Zhang Shu
Department of Gastroenterology Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China.
Department of Clinical Oncology, Taian City Central Hospital, Taian, Shandong 271000, P.R. China.
Mol Clin Oncol. 2021 Jun;14(6):110. doi: 10.3892/mco.2021.2272. Epub 2021 Apr 1.
Previous studies have reported that the combinational therapy of Lenvatinib and anti-programmed cell death-1 (PD-1) monoclonal antibody (mAb) produced a longer overall survival in patients with hepatocellular carcinoma (HCC). The current case report presented a a patient with HCC who had hepatic encephalopathy (HE) following treatment with Lenvatinib and anti-PD-1 mAb. The 42-year-old patient was diagnosed with stage IVa HCC accompanied with cirrhosis and Child-Pugh C. Computed tomography (CT) imaging revealed collateral circulation of the portal vein, causing significant varicose veins in the gastric fundus, mesenteric varices and colon edema. The patient was administered 12 mg Lenvatinib once daily combined with 240 mg anti-PD-1 mAb. After 3 days of treatment, he presented with a disorder of psychoneurosis and blood ammonia (248 µg/dl; normal levels, 40-80 µg/dl). A cranial CT scan exhibited no significant abnormalities. The patient rapidly progressed from grade 1 to grade 3 HE. Lenvatinib treatment was discontinued. After admission to the intensive care unit, the patient's blood ammonia level dropped to 132 µg/dl, after which he was discharged. It was concluded that the portal vein collateral circulation in the patient with HCC may have caused HE development whilst receiving Lenvatinib and anti-PD-1 mAb combinational therapy.
既往研究报道，乐伐替尼与抗程序性细胞死亡蛋白1（PD-1）单克隆抗体（mAb）联合治疗可使肝细胞癌（HCC）患者的总生存期延长。本病例报告介绍了1例HCC患者，其在接受乐伐替尼和抗PD-1 mAb治疗后发生了肝性脑病（HE）。该42岁患者被诊断为IVa期HCC，伴有肝硬化和Child-Pugh C级。计算机断层扫描（CT）成像显示门静脉侧支循环，导致胃底静脉曲张明显、肠系膜静脉曲张和结肠水肿。该患者每天接受12 mg乐伐替尼联合240 mg抗PD-1 mAb治疗。治疗3天后，他出现精神神经功能障碍，血氨水平为248 μg/dl（正常水平为40-80 μg/dl）。头颅CT扫描未显示明显异常。患者迅速从1级HE进展为3级HE。乐伐替尼治疗中断。入住重症监护病房后，患者血氨水平降至132 μg/dl，随后出院。结论是，HCC患者的门静脉侧支循环可能在接受乐伐替尼和抗PD-1 mAb联合治疗时导致了HE的发生。
