Combination of Anti-Programmed Death 1 Therapy and Apatinib for a Patient with Hepatocellular Carcinoma and Brain Metastasis: Case Report and Literature Review.

Abstract

Brain metastasis is rare in patients with hepatocellular carcinoma (HCC). The combination of an anti-programmed death 1 inhibitor and an anti-vascular endothelial growth factor drug provides therapeutic opportunities for refractory patients. So far, there are no data on the efficacy of these combined therapies for patients with HCC brain metastasis. HCC brain metastasis was diagnosed in a 31-year-old man. First, he underwent left liver resection and cholecystectomy and recovered well postoperatively. The postoperative pathologic findings were consistent with HCC. Approximately 2 years later, he presented with persistent headache and underwent magnetic resonance imaging, which revealed a lesion in the left parietal lobe. Anti-programmed death 1 and anti-vascular endothelial growth factor drugs were administered in combination, but the lesion did not shrink after the combined treatment on repeat magnetic resonance imaging. Therefore, surgical removal of the brain lesion was performed 2 months later. The postoperative pathologic results showed coagulative necrosis. This case report highlights the efficacy of toripalimab and apatinib in the management of brain metastasis from HCC.