P1925 - Nivolumab as a Bridge to Liver Transplantation in Advanced Hepatocellular Carcinoma

Julie Peterson, DO¹, Steven Stanek, MD², Richard Kalman, MD¹, Gabor Varadi, MD³, Balasubramani Natarajan, MD^3
1Albert Einstein Medical Center, Philadelphia, PA; ²Einstein, Philadelphia, PA; ³Einstein Medical Center, Philadelphia, PA

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer related death worldwide, particularly among patients with advanced liver disease. Surgical intervention, including transplantation, is a curative treatment, however, it is not always an option due to the extent of disease at diagnosis. Immunotherapy is rapidly becoming the standard of care for patients with advanced HCC and will allow for many patients to be successfully downstaged in order to meet transplant criteria. However, immunotherapy has a risk of possible organ rejection and safety data is limited in the setting of liver transplant.

Case Description/Methods: A 68-year-old male with a medical history of decompensated Hepatitis C cirrhosis was diagnosed in 2018 with intermediate stage HCC (Barcelona Clinic Liver Cancer Stage B). He was outside of standard transplant criteria at the time of diagnosis with a single lesion over 6.5 cm. He received a 6-month course of Sorafenib, however treatment was discontinued due to progression and intolerance. He also developed similar problems with Regorafenib. Subsequently, transarterial chemoembolization was performed twice in a three-month period. He was then started on bimonthly intravenous Nivolumab (240mg), an anti-programmed cell death protein 1 (anti PD-1) antibody used in a variety of cancers including HCC. After six months of therapy, he had a reduction in his alpha-fetoprotein and imaging showed significant decrease in tumor burden, with two remaining sub-3-cm lesions that were treated with Y90 radioembolization. Due to his impressive treatment response the Nivolumab was discontinued with close follow-up. He was listed for liver transplant and successively underwent orthotopic liver transplant (OLT) 10 months after his final dose of Nivolumab. Afterwards, his HCV was treated and sustained virologic response was attained. Our patient received his OLT seven months ago and has had an uncomplicated course with no episodes of rejection.

Discussion: Nivolumab is currently one of the second-line agents for advanced HCC treatment. However, more research is needed to compare treatment options for advanced HCC and overall patient outcomes. Our patient’s response to therapy suggests that immunotherapy may have a broader role as a bridge to transplant, a curative modality, in patients with advanced stage HCC.







Disclosures:


Julie Peterson, DO¹, Steven Stanek, MD², Richard Kalman, MD¹, Gabor Varadi, MD³, Balasubramani Natarajan, MD³. P1925 - Nivolumab as a Bridge to Liver Transplantation in Advanced Hepatocellular Carcinoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.