索拉非尼难治性肝细胞癌患者对Regorafenib继发PD-1抑制剂的序

StephenW

Complete Response to the Sequential Treatment with Regorafenib Followed by PD-1 Inhibitor in a Sorafenib-Refractory Hepatocellular Carcinoma Patient
Er-Lei Zhang  1 , Zun-Yi Zhang  1 , Jian Li  1 , Zhi-Yong Huang  1
Affiliations
Affiliation

    1
    Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China.

    PMID: 33311988 PMCID: PMC7727032 DOI: 10.2147/OTT.S284092

Free PMC article
Abstract

Most patients diagnosed with hepatocellular carcinoma (HCC) have advanced diseases, and many are not eligible for curative therapies. There is growing evidence suggesting that the combination treatment of PD-1/PD-L1 inhibitors and tyrosine kinase inhibitors (TKIs) is becoming a prospective trend for advanced HCC. For those HCC patients with sorafenib resistance, the efficacy of regorafenib combined with PD-1/PD-L1 inhibitors remains unclear. Herein, we represent a case of HCC with lung metastasis in the setting of Hepatitis B virus (HBV)-induced liver cirrhosis responding dramatically to the sequential treatment with regorafenib followed by PD-1 inhibitor after initial liver resection. A 51-year-old man diagnosed with alpha fetoprotein (AFP)-negative HCC underwent liver resection in September 2015 and was found to have solitary liver recurrence and multiple lung metastases in March 2017. He received microwave coagulation therapy (MCT) and trans-arterial chemoembolization (TACE) for liver tumor and treatment was started with sorafenib 400 mg twice daily for controlling lung metastases. In December 2018, an abdominal computerized tomography (CT) scan showed two new lesions in the liver. In March 2019, disease progression of lung metastases was measured and he received 160 mg regorafenib once daily. After a short period of partial response, in December 2019, due to the progression of the disease, he started treatment with regorafenib 160 mg in combination with sintilimab (PD-1 inhibitor) (200 mg, 3 weeks as a cycle). Surprisingly, after five cycles of sintilimab injection, he showed complete response in target lesions. There was no clinical evidence of disease progression, and the side-effects were mild. The current overall survival (OS) is 58 months. Data from this clinical case report suggest that sequential treatment with regorafenib followed by PD-1 inhibitor is a promising therapeutic option for sorafenib-refractory cases of HCCs.

Keywords: PD-1 inhibitor; hepatocellular carcinoma; regorafenib; sorafenib; sorafenib-refractory.

© 2020 Zhang et al.

StephenW

索拉非尼难治性肝细胞癌患者对Regorafenib继发PD-1抑制剂的序贯治疗的完全反应
张二雷1，张遵义1，健力1，黄志勇1
隶属关系
联系

    1个
    华中科技大学同济医学院附属同济医院肝外科中心，武汉430030

    PMID：33311988 PMCID：PMC7727032 DOI：10.2147 / OTT.S284092

免费PMC文章
抽象

大多数被诊断患有肝细胞癌（HCC）的患者患有晚期疾病，并且许多患者不符合治愈性治疗的条件。越来越多的证据表明，PD-1 / PD-L1抑制剂和酪氨酸激酶抑制剂（TKIs）的联合治疗正成为晚期HCC的潜在趋势。对于那些索拉非尼耐药的HCC患者，瑞格非尼联合PD-1 / PD-L1抑制剂的疗效尚不清楚。在本文中，我们代表一例在乙肝病毒（HBV）诱导的肝硬化患者中发生肺转移的HCC，对初始肝切除后先后用regorafenib和PD-1抑制剂的序贯治疗有显着反应。一名2015年9月被诊断为甲胎蛋白（AFP）阴性的HCC的51岁男子接受了肝切除术，并于2017年3月被发现患有单发肝复发和多处肺转移。他接受了微波凝固疗法（MCT）和经肝肿瘤的动脉化疗栓塞（TACE），并开始每天2次用400索拉非尼治疗以控制肺转移。 2018年12月，腹部计算机断层扫描（CT）扫描显示肝脏中有两个新病变。在2019年3月，测量了肺转移的疾病进展，他每天接受160 mg雷戈非尼治疗。在短暂的部分缓解后，由于疾病的进展，他于2019年12月开始用regorafenib 160 mg联合sintilimab（PD-1抑制剂）（200 mg，3周为一个周期）治疗。出人意料的是，在经过五个周期的辛蒂单抗注射后，他对靶病变表现出完全的反应。没有疾病进展的临床证据，且副作用轻微。当前的总生存期（OS）为58个月。该临床病例报告中的数据表明，对于索拉非尼难治性肝癌，先后用瑞格非尼和PD-1抑制剂依次治疗是一种有希望的治疗选择。

关键字：PD-1抑制剂；肝细胞癌；雷戈非尼索拉非尼索拉非尼难治性。

©2020 Zhang等人。

StephenW

https://www.dovepress.com/front_ ... -with-regorafen.pdf