Chao Jiashuo, Zhu Qi, Chen Desheng, An Xiao, Liu Aiqun, Zhou Fei, Yuan Lin, Wang Zhaowen, Sun Hongcheng
Department of General Surgery, Shanghai Organ Transplantation Medical Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Neoplasms and Interventional Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Oncol. 2021 Mar 29;11:667555. doi: 10.3389/fonc.2021.667555. eCollection 2021.
Transarterial chemoembolization (TACE) is inefficient at converting unresectable hepatocellular carcinoma (uHCC) to resectable. Treatment with immune checkpoint inhibitors (ICIs) is an emerging strategy for uHCC. Combined therapy of TACE with ICIs is considered to improve the therapeutic effect.
A 45-year-old man was diagnosed with a bulky HCC under cirrhotic background without distant metastasis. Curative resection was infeasible, and TACE plus tislelizumab (an ICI targeting PD-1) was applied. The treatment course, starting from TACE and followed by tislelizumab one week later, was repeated every four weeks. After three courses, the tumor showed striking shrink in volume with complete radiological response, which permitted salvage resection. Notably, pathological examination found complete necrosis of the tumor with massive infiltration of lymphocytes in the tumor-nontumor interface and extensive granulomatous inflammation in the surrounding nontumor liver, indicating activated immune response synergistically caused by TACE with tislelizumab. The patient is now living well without tumor recurrence for 6 months after surgery.
TACE in combination with tislelizumab may represent a potent strategy for uHCC. Data from randomized clinical trials are needed to assess its safety and effect in the setting of preoperative downstaging therapy.
经动脉化疗栓塞术（TACE）在将不可切除的肝细胞癌（uHCC）转化为可切除方面效率低下。免疫检查点抑制剂（ICI）治疗是uHCC的一种新兴策略。TACE与ICI联合治疗被认为可提高治疗效果。
一名45岁男性在肝硬化背景下被诊断为巨大肝癌，无远处转移。根治性切除不可行，遂应用TACE加替雷利珠单抗（一种靶向PD-1的ICI）。治疗过程为每四周重复一次，先进行TACE，一周后使用替雷利珠单抗。三个疗程后，肿瘤体积显著缩小，达到完全影像学缓解，从而允许进行挽救性切除。值得注意的是，病理检查发现肿瘤完全坏死，肿瘤-非肿瘤界面有大量淋巴细胞浸润，周围非肿瘤肝脏有广泛的肉芽肿性炎症，表明TACE与替雷利珠单抗协同激活了免疫反应。患者术后至今生活良好，无肿瘤复发已6个月。
TACE联合替雷利珠单抗可能是治疗uHCC的有效策略。需要来自随机临床试验的数据来评估其在术前降期治疗中的安全性和效果。
