Majeed Amry, Alaparthi Sneha, Halegoua-DeMarzio Dina, Eberle-Singh Jaime, Jiang Wei, Anne Pramila Rani, Shah Ashesh P, Bowne Wilbur B, Lin Daniel
Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
World J Oncol. 2024 Jun;15(3):511-520. doi: 10.14740/wjon1840. Epub 2024 May 7.
Hepatocellular carcinoma (HCC) is often diagnosed at a late stage and frequently recurs despite curative intervention, leading to poor survival outcomes. Frontline systemic therapies include combination immunotherapy regimens and tyrosine kinase inhibitors. We report a case of a 38-year-old woman with chronic hepatitis B and C coinfection-associated non-cirrhotic HCC, which recurred in the peritoneum after initial resection of her primary tumor. Disease progression occurred on both atezolizumab/bevacizumab and lenvatinib, and she was subsequently treated with gemcitabine and oxaliplatin (GEMOX) chemotherapy and exhibited a profound clinical response on imaging with normalization of alpha fetoprotein (AFP) after several months. Following extensive multidisciplinary discussion, she underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) that removed all visible macroscopic tumor. Her pathology demonstrated a complete pathologic response. She received two additional months of postoperative chemotherapy, and then proceeded with close monitoring off therapy. To our knowledge, this is the first reported case of a complete pathologic response to GEMOX chemotherapy in the context of CRS/HIPEC for peritoneal metastases in HCC, after progression on standard immunotherapy and tyrosine kinase inhibitor treatments. In this report, we review the current systemic treatment landscape in HCC. We highlight potential consideration of cytotoxic chemotherapy, which is less frequently utilized in current practice, in selected patients with HCC, and discuss the role of CRS/HIPEC in the management of peritoneal metastases. Further investigation regarding predictors of response to systemic treatments is strongly needed. Multidisciplinary management may ultimately prolong survival in patients with advanced HCC.
肝细胞癌（HCC）通常在晚期才被诊断出来，尽管进行了根治性干预，仍经常复发，导致生存结果不佳。一线全身治疗包括联合免疫治疗方案和酪氨酸激酶抑制剂。我们报告了一例38岁的女性患者，她患有慢性乙型和丙型肝炎合并感染相关的非肝硬化性HCC，在原发性肿瘤初次切除后腹膜复发。阿替利珠单抗/贝伐单抗和乐伐替尼治疗均出现疾病进展，随后她接受了吉西他滨和奥沙利铂（GEMOX）化疗，几个月后影像学显示有显著临床反应，甲胎蛋白（AFP）恢复正常。经过广泛的多学科讨论，她接受了细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC），切除了所有可见的宏观肿瘤。她的病理显示完全病理缓解。她术后又接受了两个月的化疗，然后在停止治疗后进行密切监测。据我们所知，这是第一例在标准免疫治疗和酪氨酸激酶抑制剂治疗进展后，CRS/HIPEC治疗HCC腹膜转移对GEMOX化疗产生完全病理缓解的报道病例。在本报告中，我们回顾了HCC目前的全身治疗情况。我们强调了在部分HCC患者中，细胞毒性化疗在当前实践中较少使用，但仍有潜在的考虑价值，并讨论了CRS/HIPEC在腹膜转移管理中的作用。强烈需要进一步研究全身治疗反应的预测因素。多学科管理最终可能延长晚期HCC患者的生存期。
