Wang Xin, Ji Guangbin, Chen Xi, Hu Hongbo, Zou Lianyue, Takeda Haruhiko, Zhou Caiyun
Department of Medical Oncology, General Hospital of Benxi Iron and Steel Industry Group of Liaoning Health Industry Group, Benxi, China.
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Gastrointest Oncol. 2025 Jun 30;16(3):1314-1320. doi: 10.21037/jgo-2025-433. Epub 2025 Jun 27.
BACKGROUND: Hepatocellular carcinoma (HCC) remains a global health burden, with limited therapeutic options for patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS). Current guidelines recommend best supportive care (BSC) for patients with HCC and an ECOG PS ≥3, as systemic therapies such as tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs) are typically restricted to PS 0-1 population. To our knowledge, this may be the first reported case suggesting that targeted therapy combined with ICIs could be feasible and potentially beneficial in a patient with HCC and an ECOG PS of 3. CASE DESCRIPTION: A 47-year-old male with hepatitis B-related HCC presented in August 2018 with an 80 mm × 69 mm right hepatic lobe tumor, an ECOG PS of 2, and Child-Pugh class A. He underwent curative resection and adjuvant transcatheter arterial chemoembolization (TACE). In December 2020, recurrence was noted with the tumor lesion measuring 130 mm × 120 mm with accompanying portal vein cancer thrombosis. His ECOG PS was 3 (bedridden >50% of the day), the alpha fetoprotein (AFP) level was >1,000 IU/mL, and the cancer antigen 125 (CA125) level was 118 U/mL. Despite contraindications, sorafenib was initiated but failed to improve symptoms or tumor markers. In February 2021, camrelizumab (21-day cycles) was added to ongoing sorafenib. By May 2021, the ECOG PS improved to 1, and he experienced partial response (PR) according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, and the tumor had shrunk to 87 mm × 64 mm. AFP normalized to 1.63 IU/mL by September 2023. Sorafenib was replaced with apatinib in February 2023 due to rash, but PR was maintained. At the follow-up in March 2025, the patient was alive with a 49-month progression-free survival (PFS) from camrelizumab initiation, stable disease (49 mm × 40 mm), and normal AFP and CA125 levels. Key baseline biomarkers included a neutrophil-to-lymphocyte ratio (NLR) of 3.67 and an albumin-bilirubin (ALBI) grade of 1. Treatment adherence was complicated by financial interruptions but resumed with a combination of apatinib plus camrelizumab. CONCLUSIONS: This case may provide preliminary support for the potential use of targeted therapy combined with immune checkpoint inhibitors in patients with HCC and an ECOG performance status of 3.
背景：肝细胞癌（HCC）仍然是一项全球卫生负担，对于东部肿瘤协作组（ECOG）体能状态较差的患者，治疗选择有限。当前指南推荐对ECOG PS≥3的HCC患者进行最佳支持治疗（BSC），因为酪氨酸激酶抑制剂（TKIs）或免疫检查点抑制剂（ICIs）等全身治疗通常仅限于PS 0-1的人群。据我们所知，这可能是首例报道的病例，提示靶向治疗联合ICIs对于一名ECOG PS为3的HCC患者可能是可行的且有潜在益处。 病例描述：一名47岁的男性，患有乙型肝炎相关的HCC，于2018年8月就诊，右肝叶肿瘤大小为80 mm×69 mm，ECOG PS为2，Child-Pugh分级为A级。他接受了根治性切除及辅助性经动脉化疗栓塞术（TACE）。2020年12月，发现肿瘤复发，肿瘤病灶大小为130 mm×120 mm，伴有门静脉癌栓形成。他的ECOG PS为3（一天中卧床时间>50%），甲胎蛋白（AFP）水平>1000 IU/mL，癌抗原125（CA125）水平为118 U/mL。尽管存在禁忌证，仍开始使用索拉非尼，但未能改善症状或肿瘤标志物。2021年2月，在持续使用索拉非尼的基础上加用卡瑞利珠单抗（21天周期）。到2021年5月，ECOG PS改善至1，根据实体瘤疗效评价标准（RECIST）1.1，他出现了部分缓解（PR），肿瘤缩小至87 mm×64 mm。到2023年9月，AFP恢复正常，降至1.63 IU/mL。由于出现皮疹，2023年2月将索拉非尼换为阿帕替尼，但仍维持PR。在2025年3月的随访中，患者存活，自开始使用卡瑞利珠单抗起无进展生存期（PFS）为49个月，疾病稳定（49 mm×40 mm），AFP和CA125水平正常。关键的基线生物标志物包括中性粒细胞与淋巴细胞比值（NLR）为3.67，白蛋白-胆红素（ALBI）分级为1级。治疗依从性因经济中断而复杂化，但在阿帕替尼加卡瑞利珠单抗联合治疗后恢复。 结论：该病例可能为在ECOG体能状态为3的HCC患者中潜在使用靶向治疗联合免疫检查点抑制剂提供初步支持。
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