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| Immune checkpoint inhibitor for hepatocellular carcinoma recurrence after liver transplantation |
| Li Zhuang a , b , # , Hai-Bo Mou c , # , Lan-Fang Yu c , Heng-Kai Zhu a , Zhe Yang d , Qin Liao c , Shu-Sen Zheng b , d , ∗ |
a Zhejiang University School of Medicine, Hangzhou 310 0 0 0, China
b Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China
c Department of Oncology, Shulan (Hangzhou) Hospital, Hangzhou 310022, China
d Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine,
Hangzhou 310003, China
∗ Corresponding author at: Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China.
E-mail address: shusenzheng@zju.edu.cn (S.-S. Zheng).
# Contributed equally. |
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Abstract Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancers with the highest incidence in China (more than 50% of all cases worldwide) [1] . Liver transplantation (LT) is regarded as an optimal therapy for selected HCC patients. The Milan criteria are the benchmark for candidate selection that ensure excellent prognosis for patients with HCC [2] . The Hangzhou criteria expand 51.5% more of Milan criteria for LT candidates with comparable posttransplant survivals [3] . However, LT recipients fulfilling Milan criteria or Hangzhou criteria are at the risk of up to 13%−18% HCC recurrence rate within five years [4] . Only 25%−50% of recurrent HCC patients post-LT are eligible for surgical treatment which have consistently presented favored survival benefit than systemic therapy [5] . Therefore, it worth exploring alternative treatments such as chemotherapy, targeted therapy and recently developed immune checkpoint inhibitor (ICI) treatment. Through blocking programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) signaling pathway and restoring T cell activities, ICIs are promising in the treatment of many types of cancers [6] . Despite the eager demand for effective HCC treatment options, the present opinion considers immunosuppression a contraindication for ICIs in LT recipients, whom otherwise would be exposed to great risk of organ rejection. Here, we report a case of the longest survival benefit achieved by using ICIs in an immunosuppressed LT recipient with recurrent HCC.
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2020, Vol. 19 
