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Hepatocellular Carcinoma Case Studies

Case Studies: Optimal Management of Relapsed/Refractory mHCC

Michael A. Morse, MD, FACP, reviews the treatment of a 63-year-old male with advanced hepatocellular carcinoma, through multiple lines of therapy.

Optimal Management of Relapsed/Refractory mHCC

Case: 63-Year-Old Male with R/R mHCC

February 2018: Initial presentation

  • A 63-year-old man with chronic HBV infection referred for further imaging studies based on suspicious findings during routine ultrasound for HCC

Initial Clinical Workup

  • AFP: 300 IU/mL
  • Child-Pugh A
    • Platelets: 210,000 cells/mcL
    • Bilirubin: 1.2 mg/dL
    • Albumin: 3.6 g/dL
    • INR: 1.1
    • No hepatic encephalopathy
    • Ascites not present
  • Imaging: CT revealed 2 lesions in right hepatic lobe (2cm, 5cm); no extrahepatic disease; no cirrhosis; no portal hypertension
  • BCLC: B
  • PS: 0

Treatment

  • Patient underwent right hepatectomy; negative margins; no vascular invasion
  • AFP: WNL

December 2018

  • On routine follow-up, imaging showed new lesion in left hepatic lobe (~2.3cm)
  • Chest CT showed 3 small lesions (<1cm) in upper left lobe of lung
  • Patient started on lenvatinib 12 mg QD; experienced moderate diarrhea and fatigue
  • Imaging at 3 and 6 months showed partial response
  • AFP: 100 IU/mL
  • BCLC: C
  • PS: 0

August 2019

  • Routine follow-up blood sample reveals AFP 450 IU/mL
  • CT scan showed progression in the lung and 2 new liver lesions; remains Child-Pugh A
  • Patient started on cabozantinib 60 mg QD
  • Patient developed grade 2 diarrhea; dose-reduction to 40 mg QD
  • Imaging at 3 months showed stable disease
  • Imaging at 6 months showed partial response
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