The perioperative regimen improved event-free and overall survival in the phase 3 VOLGA trial, offering a new option for patients with muscle-invasive bladder cancer who cannot receive or decline cisplatin.
|Videos|October 8, 2019
Refractory Hepatocellular Carcinoma
Refractory Hepatocellular Carcinoma
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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
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