TACE plus PD-1 successfully achieves conversion therapy for unresectable HCC with multiple macrovascular invasion: a case report

Abstract Background There is still a lack of effective treatment for patients with advanced hepatocellular carcinoma (HCC) and macrovascular invasion, and surgical resection is technically feasible but difficult to remove the tumor completely, which often leads to early recurrence. In recent years, it has been found that the combination of systematic therapy and locoregional treatment has shown better anti-tumor effect for advanced HCC than a single drug or method. Higher objective response rate with combined therapy brings new hope for conversion therapy as well. Case presentation A 32-year-old male patient was diagnosed with giant HCC with tumor thrombus formation in the right branch of the portal vein, inferior vena cava, and right atrium. After receiving 3 times transarterial chemoembolization combined with 7 cycles of PD-1 inhibitors treatment, the tumor significantly shrunk and the tumor thrombus in the inferior vena cava and right atrium disappeared. Finally, the patient underwent radical liver resection successfully. Now a year after surgery, the patient remains in disease-free survival. Conclusion TACE plus PD-1 inhibitors may be an ideal conversion regimen for patients with potentially resectable HCC, leading to more surgical resection opportunities. Neutrophil lymphocyte ratio decreased after treatment may suggest that patients respond well to PD-1-based combination therapy.