Ipilimumab and nivolumab plus radioembolization as salvage therapy for atezolizumab and bevacizumab refractory hepatocellular carcinoma resulting in complete pathologic response

TL;DR

A patient with advanced liver cancer unresponsive to first-line treatment achieved a complete response after a combination of immunotherapy and radioembolization.

Contribution

This case demonstrates a complete pathologic response using ipilimumab, nivolumab, and radioembolization in refractory hepatocellular carcinoma.

Findings

The patient achieved a complete pathologic response after treatment with ipilimumab, nivolumab, and radioembolization.

The patient remained disease-free for over 2 years following the treatment.

The combination therapy downstaged the tumor, making surgical resection possible.

Abstract

Unresectable hepatocellular carcinoma unresponsive to first-line immunotherapy has a poor prognosis with modest response to tyrosine kinase inhibitors in the second line. In these patients, the benefit of local therapy with immunotherapy rechallenge is unknown. Radioembolization is a guideline-supported locoregional therapy for HCC that has shown the potential for synergy in combination with immunotherapy. This report describes a patient with veno-invasive HCC and extrahepatic invasion of the right kidney which progressed on atezolizumab and bevacizumab and was subsequently downstaged to resection with ipilimumab and nivolumab plus radioembolization yielding a complete pathologic response. The patient is currently more than 2 years since diagnosis without evidence of disease recurrence.

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