Improved Tumor Response to Lenvatinib Re-Treatment after Failure of Immune Checkpoint Inhibitors in a Patient with Advanced Hepatocellular Carcinoma

Abstract

Dear Editor, Although immune checkpoint inhibitors (ICIs) are potential therapeutic agents for hepatocellular carcinoma (HCC), phase III clinical trials failed to show superiority over placebo in terms of prolonging survival [1]. Several reports stated that vascular endothelial signals affected the immunological microenvironment by upregulating regulatory T cells (Treg) in the tumor. We report a case of HCC with a unique clinical course, wherein administration of the tyrosine kinase inhibitor, lenvatinib, was initially ineffective, but elicited a significant response by re-lenvatinib treatment after treatment with pembrolizumab. A 56-year-old man was referred to our hospital on April 5, 2011. He was a hepatitis B virus (HBV) carrier with 8.3 log copies/mL of serum HBV-DNA and 52 IU/ mL of alanine aminotransferase (ALT). He was treated with entecavir 0.5 mg/day on April 25, 2011, and the serum HBV-DNA level rapidly decreased to an undetectable level. On October 20, 2016, CT revealed HCC measuring 2 cm in the widest diameter in segment 7 (S7) of his liver. Laparoscopic partial hepatectomy was performed on November 22, 2016. In October 2018, he began experiencing dysuria and dyschezia. A metastatic lesion in the sacrum was seen on MRI. This was confirmed by histology through needle biopsy of the sacral lesion. Table 1. Laboratory data