Complete response and long-term survival after short-course camrelizumab plus apatinib, hepatic arterial infusion chemotherapy, and transarterial chemoembolization in large and advanced hepatocellular carcinoma: a case report

Abstract

Background: In China, transarterial chemoembolization (TACE) and systemic therapy are the primary treatment for patients with advanced hepatocellular carcinoma (HCC). Hepatic arterial infusion chemotherapy (HAIC) is more effective than TACE in treating large HCC (largest diameter ≥7 cm) without macrovascular invasion or extrahepatic spread. Additionally, HAIC in combination with camrelizumab and apatinib has shown promising efficacy and safety in the Barcelona Clinic Liver Cancer stage C (BCLC-C) HCC. The efficacy and safety of the modality of HAIC followed by TACE combined with camrelizumab and apatinib for the treatment of large HCC remains unknown. We present the first case of long-term survival after short-course HAIC followed by TACE combined with camrelizumab and apatinib in large HCC.

Case description: In April 2020, a 50-year-old Chinese woman was diagnosed with BCLC-C HCC. Magnetic resonance imaging (MRI) showed intrahepatic lesions involving the right and left lobes, with a total lesion size of 19 cm × 9 cm. After 3 cycles of HAIC with oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) plus camrelizumab and apatinib, followed by 2 cycles of TACE plus camrelizumab and apatinib, the efficacy was evaluated as a partial response (PR), with a total lesion size of 6.7 cm × 4.6 cm. The patient continued to take apatinib orally for 1.5 months after the last cycle of TACE but discontinued any antitumor therapy for financial reasons. Subsequent imaging consultation showed an efficacy evaluation of complete response (CR) per the modified Response Evaluation Criteria in Solid Tumors (mRECIST). The patient did not experience any serious adverse events during treatment. As of September 2024, the patient's progression-free survival (PFS) has reached 53 months.

Conclusions: The treatment modality of short-course HAIC followed by TACE combined with camrelizumab and apatinib for large HCC is safe and effective, and long-term survival may be expected in patients who achieve a CR.

Keywords: Hepatocellular carcinoma (HCC); case report; hepatic arterial infusion chemotherapy (HAIC); immune checkpoint inhibitors (ICIs); transarterial chemoembolization (TACE).