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