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免疫检查点抑制剂治疗肝癌后行肝动脉化疗栓塞术出现意外抗肿瘤效应。

Unexpected anti-tumor effect of immune checkpoint inhibitors followed by transcatheter arterial chemoembolization for hepatocellular carcinoma.

机构信息

Department of Gastroenterology, Osaka Red Cross Hospital, 5-30, Fudegasakicho, Tennouji-ku, Osaka, 543-8555, Japan.

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

出版信息

Clin J Gastroenterol. 2023 Dec;16(6):891-894. doi: 10.1007/s12328-023-01858-y. Epub 2023 Sep 28.

Abstract

The abscopal effect has recently attracted much attention because this effect is enhanced by immune checkpoint inhibitors (ICIs). However, little is known about the association between induction of the abscopal effect and local treatment against hepatocellular carcinoma (HCC). We describe a patient with advanced HCC who underwent selective transcatheter arterial chemoembolization (TACE) after treatment with an ICI that was found to remarkably regress in lesions in areas outside that targeted by selective TACE. An 82-year-old man had multiple recurrences in both lobes of the liver despite of repeated TACE and radiofrequency ablation, after resection of an HCC five years previously. After chemotherapy with atezolizumab and bevacizumab, his des-gamma-carboxy prothrombin (DCP) increased. CT during hepatic arteriography revealed multiple recurrent HCCs in both lobes of the liver. TACE with selective embolization at the level of the medial segmental arteries was performed against an approximately 50 mm-diameter tumor in the right lobe. Hepatic arterial phase imaging of contrast-enhanced CT performed 6 days after TACE showed hypo-enhancement of tumors in segment II and III in the left lobe. This case highlights that abscopal effects can be induced by local treatment against HCCs in combination with treatment with ICIs.

摘要

远隔效应最近引起了广泛关注,因为这种效应会被免疫检查点抑制剂(ICIs)增强。然而,对于诱导远隔效应与局部治疗肝细胞癌(HCC)之间的关系知之甚少。我们描述了一名患有晚期 HCC 的患者,在接受 ICI 治疗后进行了选择性经导管动脉化疗栓塞(TACE),结果发现 TACE 靶向区域以外的病变明显消退。一名 82 岁男性,在五年前 HCC 切除术后,尽管反复接受 TACE 和射频消融治疗,但仍在两叶肝脏中多次复发。在接受阿替利珠单抗和贝伐珠单抗化疗后,其脱-γ-羧基凝血酶原(DCP)升高。肝动脉造影 CT 显示两叶肝脏中有多个复发性 HCC。对右叶约 50mm 直径的肿瘤进行了选择性栓塞于内侧节段动脉的 TACE。TACE 后 6 天进行的增强 CT 肝动脉期成像显示左叶 II 段和 III 段的肿瘤呈低增强。该病例强调了 HCC 的局部治疗与 ICI 治疗相结合可以诱导远隔效应。

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