多纳非尼联合HAIC和信迪利单抗治疗伴下腔静脉癌栓的肝细胞癌并完全缓解一例

目的 探讨多纳非尼联合肝动脉灌注化疗（HAIC）和抗PD-1抗体信迪利单抗对肝细胞癌合并下腔静脉癌栓患者的疗效。方法 1例肝细胞癌合并下腔静脉近右心房癌栓的患者，接受多纳非尼联合HAIC和信迪利单抗治疗。通过实体瘤的疗效评价标准RECIST v1.1评估肿瘤治疗反应情况，观察甲胎蛋白（AFP）和异常凝血酶原（PIVKA-Ⅱ）指标符合要求后，进行手术治疗。结果 经过多纳非尼联合HAIC和信迪利单抗治疗4个周期后，成功缩小肝脏肿瘤及下腔静脉癌栓，AFP降至正常。采用全肝血流阻断法和下腔静脉切开取栓术完整切除肝脏肿瘤及癌栓，手术获得成功。术后病理提示肿瘤完全缓解。结论 多纳非尼联合HAIC和信迪利单抗可作为治疗肝癌合并下腔静脉癌栓患者的转化治疗方案。

Donafenib combined with HAIC and sintilimab for hepatocellular carcinoma with tumor thrombus in inferior vena cava and achieved complete remission: a case report

Objective To investigate the effect of hepatic artery infusion chemotherapy combined with targeted and immunotherapy on hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT). Methods A case of hepatocellular carcinoma with tumor thrombus in the inferior vena cava (IVC) near the right atrium was treated with donafenib combined with hepatic artery infusion chemotherapy (HAIC) and sintilimab. The response of tumor treatment was evaluated by RECEST v1.1. The dynamic changes of alpha-fetoprotein (AFP) and PIVKA-Ⅱ were observed and the surgical procedure was introduced. Results After four cycles of treatment with donafenib combined with HAIC and sintilimab, the diameter of the tumor and the tumor thrombus in IVC were successfully reduced, and AFP was reduced to normal. Both tumor and tumor thrombus were completely removed by total hepatic vascular exclusion (THVE) with the IVC incision. Postoperative pathology showed complete remission of the tumor. Conclusion Donafenib combined with HAIC and sintilimab has a good tumor shrinking effect for HCC with IVCTT, and can be applied for conversion surgery for patients of HCC with IVCTT.