Long-term remission by nivolumab monotherapy for sorafenib-refractory hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is considered to be a relatively chemotherapy-resistant tumor. There was no standard systemic therapy for patients with metastatic HCC until 2007 when sorafenib was demonstrated to be superior to supportive care. Lenvatinib has also been used as a first-line choice since a randomized phase III noninferiority trial was conducted in 2018. In the second-line setting, regorafenib was the first drug to be approved for sorafenib-refractory advanced HCC. Other drugs such as cabozantinib and ramucirumab have also shown benefits in a second-line setting. Immunotherapy is another novel and well-tolerated treatment option for patients who are refractory to tyrosine kinase inhibitors. Here, we present a patient with HCC which progressed after sorafenib treatment, and who subsequently achieved a nearly complete remission after nivolumab monotherapy. Maintenance therapy with nivolumab every 2–3 months was prescribed to sustain the good response based on a previous study that used rituximab maintenance therapy in a patient with follicular lymphoma.