Abstract:

Objective

To evaluate the efficacy and share the experience of TACE combined with targeted immunotherapy for middle stage and advanced liver cancer.

Methods

A 50-year-old male patient was admitted to our hospital due to ＂a liver mass detected in physical examination＂ on June 12, 2021.Diagnosis upon admission: primary liver cancer (CNLC stage Ⅲa), chronic hepatitis B and cholecystolithiasis.Child-Pugh A, and Eastern Cooperative Oncology Group-Performance Status (ECOG-PS)score was 0.Preliminary evaluation indicated that radical resection could not be performed, and subsequent multidisciplinary team (MDT) diagnosis and treatment consultation recommended TACE combined with targeted immunotherapy.The protocol was given as follows: 8 mg of lenvatinib once a day and 200 mg of camrelizumab once every two weeks.After 6-month targeted immunotherapy and twice TACE, the tumor was significantly controlled.

Results

After active preoperative preparations, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)-Ⅰ stage surgery was performed on January 27, 2022.Laparoscopic ligation of the right portal vein combined with hepatic tissue dissection and cholecystectomy was adopted.Laparoscopic right trisectionectomy was performed on April 22, 2022.The patient achieved successful postoperative recovery without postoperative complications.Postoperative pathological examination showed that the liver lesion was coagulation necrosis, and multinucleated giant cell reaction and granulation tissue hyperplasia could be seen on the margins of necrotic tissues.No cancer was found in the liver tissue ≥ 1 cm and ＜ 1 cm from the lesion, and no tumor thrombus was found in the vessels.In the postoperative follow-up until August, 2023, no recurrence or metastasis was found.Portal vein tumor thrombus was absent.Until the paper submission date, the patient was continually treated with lenvatinib combined with camrelizumab.

Conclusions

ALPPS after TACE combined with targeted immunotherapy can bring benefits to partial patients with middle stage or advanced liver cancer.

Key words: Carcinoma, hepatocellular, Middle stage and advanced, Targeted therapy, Immunotherapy, Conversion therapy, Chemoembolization, therapeutic, Hepatectomy, ALPPS