Refractory Hepatocellular Carcinoma

October 8, 2019

Refractory Hepatocellular Carcinoma


Case: A 65-year-old Man With Cirrhosis and HCC

A 65-year-old man with 10-year history of cirrhosis was seen for routine follow-up; referred for further lab and imaging studies based on enlarged lymph nodes and new-onset jaundice.

H & P

  • PE: Yellowing of the skin and sclerae
  • Social History: drinks 20+ alcoholic beverages/ week for the past 15 years
  • ECOG: 0

Labs

  • AFP: 550 IU/mL
  • Child-Pugh B
    • Bilirubin: 3 mg/dL
    • Albumin: 3.5 g/dL
    • No hepatic encephalopathy
    • Grade 1 ascites

Imaging

  • Multiphasic contrast MRI of the abdomen revealed an 8-cm encapsulated mass in the left hepatic lobe showing hypervascularity on arterial phase and washout on venous phase
  • Further imaging of CAP revealed no metastasis
  • Diagnosis: unresectable hepatocellular carcinoma

Treatment

  • Underwent TACE; follow-up imaging at 1 month showed no response
  • Started on lenvatinib 12 mg once daily; follow-up imaging at 3 months showed no response
  • Received nivolumab 3 mg/kg every 2 weeks

Follow-up

  • 3 months later; patient complained of increasing fatigue
  • AFP; 600 IU/mL
  • MRI showed disease progression in the liver, one new adrenal lesion