Shao Min Huang, China Medical University Hospital, Taichung, Taiwan
Long-Bin Jeng, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
Woei-Cherng Shyu, Translational Medicine Research Center, Drug Development Center and Department of Neurology, China Medical University Hospital, Taichung, Taiwan
Hung-Yao Chen, Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanFollow

Background: Recently, immunotherapy has emerged as a promising method for advanced HCC treatment. There are several clinical trials and meta-analyses of immune checkpoint inhibitors and immune cell therapy, but clinical evidence on the combination of these two therapies is lacking. Case description: A 66-year-old man with chronic hepatitis B-related cirrhosis complained of acute abdominal pain in an emergency department of a hospital. On exams, there was a palpable mass in the right upper quadrant of his abdomen. Contrast-enhanced abdominal computed tomography showed a large tumor in the right lobe, 13 cm x 17cm in size, and right portal vein thrombosis. The alpha-fetoprotein(AFP) level was 30905 mg/dL. Therefore this patient was diagnosed with BCLC stage C hepatocellular carcinoma(HCC). He underwent trans-arterial chemo-embolization(TACE), abdominal radiotherapy, nivolumab, and lenvatinib. His disease had been under control until two years later, the disease progressed with multiple lung metastases, and his AFP level rose from around 1000 to 17000 ng/ml. At this stage, he underwent new combination immunotherapy in January 2022. He used pembrolizumab(100mg) first, and the AFP level decreased by 600ng/ml daily. Then he received DC-CIK cell therapy two weeks after using pembrolizumab, and the AFP level declined to 900ng/ml a day. Unfortunately, severe pneumonitis and tension pneumothorax developed after therapy. The patient denied undergoing further treatment and expired peacefully. Conclusion: The previous in-vivo study found that combination immunotherapy can improve tumor control in the mice model. Besides, in previous clinical studies, the level of AFP may be a surrogate marker of tumor response. Therefore we thought the more rapidly declined level of AFP was the clinical evidence of the synergistic effect of checkpoint inhibitors combined with cell therapy in HCC treatment.

Huang, Shao Min; Jeng, Long-Bin; Shyu, Woei-Cherng; and Chen, Hung-Yao (2023) "Combination treatment of pembrolizumab with DC-CIK cell therapy for Advanced hepatocellular carcinoma: a case report," BioMedicine: Vol. 13 : Iss. 3 , Article 6.
DOI: 10.37796/2211-8039.1414