Journal of Liver Cancer

Original Article

Cure can be Achieved by Conversion to Microwave Ablation following Atezolizumab-Bevacizumab Therapy in Unresectable Hepatocellular Carcinoma: Rene John D. Febro, Engelbert Simon S. Perillo, Akemi A. Kimura, Stephen N. Wong; Received February 19, 2024 Accepted May 23, 2024 Published online June 3, 2024; DOI: https://doi.org/10.17998/jlc.2024.05.23 [Accepted]

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Abstract PDF: Introduction
Atezolizumab/bevacizumab is the recommended first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC) and may facilitate curative conversion through resection and locoregional therapies. However, there have been very few reports on curative conversion using microwave ablation (MWA). This study aimed to determine the curative conversion rate with MWA using atezolizumab-bevacizumab as the first-line treatment in patients with uHCC, and to compare the characteristics and survival of patients with and without curative conversion.
Methods
Consecutive patients with uHCC who were started on atezolizumab-bevacizumab from May 2021 and December 2023 in a single tertiary center were included. Objective response (ORR) and disease control rate (DCR) were based on the RECIST 1.1 and mRECIST criteria.
Results
Twenty consecutive patients with uHCC (60% advanced-stage) were included, 90% exceeding the up-to-7 criteria. The ORR and DCR were 35% and 60%, and 35% and 55% using RECIST and mRECIST, respectively. Five (25%) patients underwent successful curative conversion with MWA (4 advanced and 1 intermediate stage) despite a median HCC size of 6.1 (range: 2.4-7.3) cm. Two of these patients were tumor and drug-free 132-133 weeks from the 1^st atezolizumab-bevacizumab dose. Patients who underwent curative conversion had significantly longer survival than those who did not. (p=0.024) Other factors associated with survival were male sex, Child-Pugh class A, and an objective response.
Conclusions
Despite the relatively large tumor size, successful curative conversion with MWA was achieved with first-line atezolizumab-bevacizumab in uHCC. However, data from prospective multicenter trials are required to determine whether this strategy is universally applicable.

Case Reports

A Case of Achieving Complete Remission with Combination of Sorafenib and Tegafur in Patients with Hepatocellular Carcinoma with Progression of Disease after Sorafenib Therapy: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Ki Jeong Jeon, Sang Bu Ahn, Jin-Young Park, Cheol-Won Choi, Kwang-Mo Yang; J Liver Cancer. 2017;17(1):88-93. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.88

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Abstract PDF: Sorafenib is the only approved targeted agent as the first line systemic therapy for treatment of advanced hepatocellular carcinoma (HCC). However, the improvement of survival duration under 3 months is far from clinical satisfactory and most patients experience disease progression within 6 months after sorafenib therapy. Unfortunately, second line systemic therapy after treatment failure of sorafenib was not established and there were no clear guidelines for salvage treatment modalities. Recently, studies suggests that combination of sorafenib and single cytotoxic agent can be relatively effective and safe strategy that achieves promising rates of local and systemic control in advanced HCC patients. Based on above suggestions, we herein offer our experience of a case achieved complete remission by combination therapy of sorafenib and tegafur in the patient with progressed disease after sorafenib therapy.

A Case of Hepatocellular Carcinoma with Improved Decompansated Liver Cirrhosis with Combination Treatment of Transarterial Chemoembolization and Radiofrequency Ablation: Hyung Min Yu, Won Hyeok Choe, So Young Kwon, Jeong Han Kim; J Liver Cancer. 2014;14(2):131-134. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.131

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Abstract PDF: A 54-year-old female patient with no medical history visited our hospital complaining of both pretibial pitting oedema for 6 months, and abdominal distension for 1 month. Computed tomography and magnetic resonance imaging revealed an 2.3cm sized tumour at segment 2 of the liver. Her Child-Turcotte-Pugh (CTP) class was C (score 11) at the initial visit. She was diagnosed as hepatocellular carcinoma (UICC stage II, BCLC stage D), and then she underwent conservative treatment for 1 month. After one month of conservative treatment, her liver function was improved to CTP class B (score 8), and then she underwent combination treatment of transarterial chemoembolization and radiofrequency ablation. However, her liver function was deteriorated gradually. She was transferred to other hospital for liver transplantation eventually. (J Liver Cancer 2014;14:131-134)

A Case of Achieving Partial Remission with Combination of Radiation Therapy and Sorafenib inChild-Pugh Class B Patients with Hepatocellular Carcinoma with Main Portal Vein Invasion and Lymph Node Metastasis: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Joon Suk Kim, Sang Bu Ahn, Eun Kyeong Ji, Hyun-Cheol Kang, Cheol-Won Choi, Gwang-Mo Yang; J Liver Cancer. 2014;14(2):120-126. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.120

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Abstract PDF: Reserved liver function is one of the most important determinants of survivial in advanced hepatocellular carcinoma (HCC). Especially in cirrhotic patient with decompensated liver function, sorafenib for HCC with main portal vein invasion have limited efficacy and survival benefit. Therefore many clinicians or centers still try locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib in this situation. However this multidisciplinary approach may increase treatment related toxicity such as liver failure, etc. Recently, studies for combination of RT and sorafenib for HCC with portal vein invasion have been tried and reported not only better therapeutic efficacy, but also more hepatic toxicity.Based on above suggestions, we herein offer our experience of a patient that although achieved survival gain via partial remission of intrahepatic tumor and main portal vein thrombosis and metastatic lymph node by combination therapy of RT and sorafenib, finally expired due to hepatictoxicity. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage decompenstated cirrhotic patients with HCC with main portal vein invasion. (J Liver Cancer 2014;14:120-126)

A Case of Early Hepatocellular Carcinoma Treatment Combined by Transarterial Chemoembolization and Radiofrequency Ablation: Jun Uk Lim, Hyun Phiil Shin, Joung Il Lee, Jae Jun Park, Jung Won Jeon, Kyuseong Lim; Journal of the Korean Liver Cancer Study Group. 2012;12(1):32-36. Published online February 28, 2012

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Abstract PDF: In most early hepatocellular carcinoma (HCC), surgical resection or liver transplantation is the first choice of treatment. However, surgery is often impossible because of patient’s physical condition such as advanced liver cirrhosis, other comorbidities, and radiofrequency ablation (RFA) can be used as substitute treatment. Recently, it has been reported that clinical outcomes of transarterial chemoembolization (TACE) combined with RFA were similar to that of surgical resection. This report describes a 49-year-old male with 1.5 cm sized HCC. Because the patient could not undergo surgical resection and the tumor was not localized on ultrasonography (US), TACE was performed instead. But the residual tumor was still detected on follow-up contrast enhanced US, we performed additional RFA. After combined treatment with TACE and RFA, viable portion of the tumor was not detected on one month follow-up CT and MRI image. The patient remains well without recurrence, 12 months after combined treatment. It is suggested that TACE combined with RFA can be an alternative choice of early small HCC treatment.

Treatment of Small Hepatocellular Carcinoma by Transarterial Chemoembolization and Consecutive Radiofrequency Ablation: Byung Kook Kim, So Young Kwon, Soon-Young Ko, Won Hyeok Choe, Chang Hong Lee, Min Woo Lee, Young Jun Kim, Sang Woo Park; Journal of the Korean Liver Cancer Study Group. 2008;8(1):115-119. Published online June 30, 2008

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Abstract PDF: Surgical resection has been considered to be the best treatment for early-stage hepatocellular carcinoma (HCC). However, radiofrequency ablation (RFA) has been reported to be more effective than other local ablation treatments and transarterial chemoembolization (TACE) in achieving complete tumor necrosis. Recently, combined chemoembolization and RFA may improve both overall and recurrence-free survival rates in patients with early stage HCC. RFA have not been applied in cases of that tumors were non-visualization on ultrasonography, and located near by large vessels, main bile ducts, and major extra-hepatic organs. we found that tumor, which was not shown on ultrasonography before TACE, can be visible for several days just after TACE. We report the clinical course and complete necrosis of tumor in two cases of small HCC by TACE and consecutive RFA within a few days.

A Case of Advanced Hepatocellular Carcinoma Successfully Treated by Repeated Transcatheter Arterial Chemoembolization, Percutaneous Ethanol Injection and Surgical Resection: Jaejun Shim, Byung-Ho Kim, Jae Young Jang, Seok Ho Dong, Hyo Jong Kim, Young Woon Chang, Rin Chang, Sung Hwa Hong, Joo Hyeong Oh; Journal of the Korean Liver Cancer Study Group. 2008;8(1):120-123. Published online June 30, 2008

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Abstract PDF: Here we report a case of multifocal advanced hapatocellular carcinoma successfully treated by repeated transc atheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI) and surgical resection. Previously healthy 54-year old man was admitted for the evaluation of incidental hepatic masses. Abdominal CT revealed multifocal hepatic masses in right lobe including segment 5, 6 and 8, which showed early wash-out pattern in portal phase and increased serum alpha fetoprotein (>840 ng/mL) was compatible with advanced hepatocelluar carcinoma (stage III). Underlying cirrhosis was noted and Child-Pugh classification was A (5 points). After 4 cycles of TACE, nodular masses in segment 6 and 8 were completely lipiodolized. Viable mass in the remained huge mass in right anterior lobe was treated by surgical resection. After 4 month operation, abdominal CT revealed new hepatoma lesion at right anterior lobe, serum AFP was increased to 61 ng/mL. The lesion was treated by one session of TACE. Underlying chonic hepatitis C was also treated with interferon and ribavirin. The patient has been followed for 9 years without evidence of regional tumor recurrence or distant metastasis.

Excellent Response to Hepatic Arterial Infusional Chemotherapy in Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Keun-Ho Lee, Ja Kyung Kim, Kwang-Hyub Han, Jong Tae Lee, Do Youn Lee, Jong Yoon Won, Hyun Woong Lee, Hwa Sook Kim, Ki Tae Yoon, Sang Hoon Ahn, Chae Yoon Chon, Young Myoung Moon; Journal of the Korean Liver Cancer Study Group. 2006;6(1):42-46. Published online June 30, 2006

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Abstract PDF: There is no treatment of curative aim in advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT), which is associated with poor prognosis. Albeit one of the treatment options is intra-arterial infusional chemotherapy, its therapeutic efficacy was minimal. In this report, we present an unusual case of a patient with favorable result after intra-arterial infusional chemotherapy. This patient was HBV carrier and diagnosed having HCC of stage IVb (T4N0M1) with right PVT on February 1999. Direct right adrenal gland and right kidney invasion and numerous intrahepatic metastases were also noted. The serum AFP level showed more than 60,000 ng/mL, and the Child-Pugh score was 5 (class A). The patient received three sessions of intra-arterial 5-fluorouracil (5-FU) and cisplatin combination chemotherapy and two additional sessions of systemic (5-FU) chemotherapy combined with intra-arterial cisplatin infusion. After total 5 sessions of combination chemotherapy, follow-up CT scan revealed grossly total necrosis of main HCC and numerous intrahepatic metastases, without evidence of viable portion in July 1999. The AFP level decreased to 79.4 ng/mL. The latest CT scan taken in November 2005 also showed no evidence of recurrence. It is noteworthy that the patient with advanced HCC with PVT showed complete remission only after 5 sessions of intra-arterial chemotherapy and the status of complete remission is maintained for more than 76 months.

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