Case report: Combination therapy for hepatocellular carcinoma with inferior vena cava or right atrial tumor thrombus in the era of combined targeted and immunotherapeutic agents

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Abstract

Primary liver cancer, predominantly hepatocellular carcinoma (HCC), is a leading cause of cancer-related mortality. Tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) significantly worsens prognosis. We present four cases of male patients (average age 57) with HCC and TT extending into the IVC/RA, treated at our center. All underwent hepatectomy and TT resection, with targeted therapy (lenvatinib) and immunotherapy (sintilimab) administered post-operatively. Case 1 involved a 59-year-old male who had a right hepatectomy and TT resection in the IVC, followed by targeted therapy and immunotherapy, and is currently alive 74 months post-treatment. Case 2, a 48-year-old male, had a right hepatic lobectomy and TT resection in the IVC/RA, followed by liver transplantation 54 months postoperatively, with no recurrence. Case 3, a 66-year-old male, underwent a left hepatectomy and TT resection in the IVC, remaining disease-free 27 months postoperatively. Case 4, a 55-year-old male, received 15 cycles of combined targeted and immune therapy, followed by left hepatectomy and TT resection in the IVC/RA, with no recurrence 22 months postoperatively. Surgical resection combined with targeted and immunotherapy may enhance survival in advanced HCC patients with TT in the IVC/RA. Further studies are required to corroborate these findings.

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This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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Author and article information

Contributors

Yubin Hai: URI : https://loop.frontiersin.org/people/2796370Role: Role: Role: Role: Role: Role: Role:

Tingting Lin: Role: Role: Role: Role:

Guangyi Wang: URI : https://loop.frontiersin.org/people/2224780Role: Role: Role: Role: Role:

Xiaodong Sun: Role: Role: Role: Role:

Lan Wang: URI : https://loop.frontiersin.org/people/2771460Role: Role: Role:

Yuying Hai: Role: Role: Role: Role: Role:

Saisai Chen: Role: Role: Role:

Xiaoju Shi: Role: Role: Role: Role: Role: Role: Role: Role: Role:

Journal

Journal ID (nlm-ta): Front Oncol

Journal ID (iso-abbrev): Front Oncol

Journal ID (publisher-id): Front. Oncol.

Title: Frontiers in Oncology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2234-943X

Publication date (Electronic): 11 December 2024

Publication date Collection: 2024

Volume: 14

Electronic Location Identifier: 1470374

Affiliations

[1] ¹ Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University , Changchun, China

[2] ² Department of Hepatobiliary and Pancreatic Surgery II, General Surgery Center, The First Hospital of Jilin University , Changchun, China

[3] ³ School of Stomatology, Jilin University , Changchun, China

[4] ⁴ Department of Neurology, Stroke Center, The First Hospital of Jilin University , Changchun, China

Author notes

Edited by: Hongwei Cheng, University of Macau, Macao SAR, China

Reviewed by: Guoqing Zhang, First Affiliated Hospital of Zhengzhou University, China

Xiaoliu Liang, Guangxi Medical University, China

*Correspondence: Xiaoju Shi, shixiaoju416@ 123456126.com

†These authors have contributed equally to this work and share first authorship

Article

DOI: 10.3389/fonc.2024.1470374

PMC ID: 11668667

PubMed ID: 39723391

SO-VID: af461512-710f-42e7-b53f-cf579dd4cd22

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 25 July 2024

Date accepted : 20 November 2024

Page count

Figures: 4, Tables: 1, Equations: 0, References: 52, Pages: 11, Words: 4522

Funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work is supported by the grant from the Cross Discipline Project of First Hospital of Jilin University, China (JDYYJCHX2020001) and Research and development of multi-targeted biomimetic exosome nanomaterials for primary liver cancer, China (20210204183YY).

Custom metadata

section-in-acceptance Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: hepatocellular carcinoma,tumor thrombus,hepatectomy,targeted and immunotherapeutic drugs,case report

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: hepatocellular carcinoma, tumor thrombus, hepatectomy, targeted and immunotherapeutic drugs, case report