A Patient with Hepatocellular Carcinoma (HCC) Treated with Nivolumab (Opdivo) post Sorafenib скачать в хорошем качестве

A Patient with Hepatocellular Carcinoma (HCC) Treated with Nivolumab (Opdivo) post Sorafenib

Excellent Response to Anti-PD-1 Therapy in a Patient With Hepatocellular Carcinoma: Case Report and Review of Literature Discov Med. 2017 May; 23(128):331-336. A 79-year-old man with diabetes mellitus, hypertension, hyperlipidemia, and hypothyroidism presented with worsening back pain and found to have large heterogeneous irregular mass within the right hepatic lobe on CT imaging. A subsequent MRI abdomen showed at least 2 hepatic lesions with the largest measuring up to 7.9 x 7.6 cm in dimension with nonspecific imaging characteristics. Serum alpha-fetoprotein (AFP) was 117 ng/mL at that time. Because of the lack of characteristic radiologic appearance of the liver lesions for HCC (hyperenhancement during arterial phase and delayed washout in venous phase), he underwent ultrasound guided core needle biopsy of the lesion in segment 8 which confirmed the diagnosis of well differentiated hepatocellular carcinoma in a background of cirrhosis secondary to hemochromatosis and NASH (Figure 2A). Viral infection was ruled out. He was initially treated with sorafenib and ipafricept on a clinical trial due to multifocal disease and good liver function (Child-Pugh class A cirrhosis). Ipafricept is a fusion protein comprised of the cysteine-rich domain of frizzled family receptor 8 (Fzd8) fused to the human immunoglobulin Fc domain with potential antineoplastic activity. Despite doing clinically well, he had radiographic progression of disease after 4 months of treatment. Due to lack of an available clinical trial, he was started on off-label nivolumab (3 mg/kg IV every 2 weeks) based on the phase II data mentioned above (El-Khoueiry et al., 2015). Baseline computed tomography (CT) showed two large liver lesions but no extrahepatic disease (Figure 1A). Restaging CT after 4 cycles of nivolumab showed an increase in the size of the liver lesions but no new lesions (Figure 1B). At this time, his alpha-fetoprotein (AFP) also increased to 3,246 ng/mL as compared to 1,232 ng/mL which was the level after the patient progressed with the treatment of sorafenib and ipafricept but before nivolumab was started. The patient was continued on nivolumab due to lack of any other effective treatments, clinical stability, and possibility of pseudoprogression. Repeat imaging after 8 cycles of nivolumab (4 months) showed a significant decrease in the size of the liver lesions and AFP decline to 68 ng/mL (Figure 1C). The patient remained on biweekly treatments with bimonthly restaging scans. His tumor size continued to decrease until cycle 12 of nivolumab, and remained stable thereafter until last restaging after cycle 19 (9 months) of nivolumab. Similarly, his AFP continued to decrease until cycle 12 of nivolumab, and become normal (less than 25 ng/ml) thereafter until last restaging after cycle 19 (9 months) of nivolumab.