Successful liver transplantation with ctDNA clearance after PD‑1 inhibitor plus FOLFOX‑HAIC treatment in HCC: A case report

Zhao,Yuanyuan; Chen,Dong; Yang,Bo; Xu,Jing; Wang,Lu; Huang,Guobin; Wei,Lai; Chen,Zhishui

doi:10.3892/ol.2023.14185

Successful liver transplantation with ctDNA clearance after PD‑1 inhibitor plus FOLFOX‑HAIC treatment in HCC: A case report

Authors:
- Yuanyuan Zhao
- Dong Chen
- Bo Yang
- Jing Xu
- Lu Wang
- Guobin Huang
- Lai Wei
- Zhishui Chen
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Affiliations: Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei 430030, P.R. China
Published online on: December 12, 2023 https://doi.org/10.3892/ol.2023.14185
Article Number: 51

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Abstract

Liver transplantation (LT) is the primary treatment for patients with early‑stage hepatocellular carcinoma (HCC). However, the 5‑year survival rate after LT remains low for patients with advanced HCC. Recently, combining programmed cell death protein‑1 (PD‑1) inhibitors with hepatic arterial infusion chemotherapy (HAIC) has achieved promising outcomes in advanced HCC treatment. However, there is a lack of sufficient clinical data demonstrating its effectiveness as a pre‑LT down‑staging treatment. The current study presented a case of advanced HCC beyond the Milan criteria who underwent LT and achieved a favorable outcome following PD‑1 inhibitor combined with FOLFOX‑HAIC therapy. Of note, due to treatment‑induced tumor necrosis, precise post‑treatment tumor size evaluation became challenging. To address this, circulating tumor DNA (ct‑DNA) clearance was used as the LT criterion. After three cycles of Pembrolizumab and FOLFOX‑HAIC therapy, the patient's serum ctDNA became undetectable and serum α‑fetoprotein levels returned to normal. Magnetic resonance imaging results also revealed a significant reduction in liver tumor size post down‑staging treatment. Subsequent to LT, serum ctDNA was monitored every two months, consistently yielding diminished results. There were no clinical signs of recurrence 19 months post‑LT. These findings suggest that Pembrolizumab in combination with FOLFOX‑HAIC may serve as a potential down‑staging strategy prior to LT. In addition, ctDNA clearance may be considered a viable biomarker for LT eligibility.

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