Peritoneal specimen shows no tumor
- Thomas Jefferson University Hospital clinicians reported a 38-year-old woman with recurrent hepatocellular carcinoma and peritoneal metastases had no viable tumor left after gemcitabine-oxaliplatin chemotherapy, surgery, and heated intraperitoneal chemotherapy. - The team said pathology after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy showed a complete pathologic response, after the cancer had already progressed on atezolizumab-bevacizumab and lenvatinib. - Peritoneal spread from liver cancer is rare and usually carries poor outcomes, with older series estimating it in 2% to 6% of cases. (annals.edu.sg)
Liver cancer usually starts in the liver, but in rare cases it sheds cells into the lining of the abdomen, where tumors can spread across the peritoneum. (annals.edu.sg) That pattern is called peritoneal metastasis, and older reviews describe it as uncommon in hepatocellular carcinoma, the main form of primary liver cancer. Autopsy and laparoscopy series cited rates of about 2% to 6%. (annals.edu.sg) A 2024 case report from Thomas Jefferson University Hospital described a 38-year-old woman with chronic hepatitis B and C coinfection-associated hepatocellular carcinoma that came back in the peritoneum after her original liver tumor was resected. (jdc.jefferson.edu) Her disease worsened on atezolizumab plus bevacizumab, then on lenvatinib, two standard systemic treatments used in advanced hepatocellular carcinoma. The team then switched to gemcitabine plus oxaliplatin, a chemotherapy combination often shortened to GEMOX. (jdc.jefferson.edu) The report said imaging showed a strong response after several months of GEMOX, and her alpha-fetoprotein, a blood marker often tracked in liver cancer, returned to normal. (jdc.jefferson.edu) After multidisciplinary review, surgeons performed cytoreductive surgery, which aims to remove all visible tumor, and hyperthermic intraperitoneal chemotherapy, or HIPEC, which circulates heated chemotherapy through the abdomen during the operation. (jdc.jefferson.edu) The pathology result was the key finding: the resected tissue showed a complete pathologic response, meaning no viable cancer cells were found in the specimen. The authors said this was the first reported complete pathologic response to GEMOX in this setting after progression on immunotherapy and a tyrosine kinase inhibitor. (jdc.jefferson.edu) The case does not mean this sequence is established standard care. The same report said cytotoxic chemotherapy is used less often in current hepatocellular carcinoma practice and called for more study on which patients might respond. (jdc.jefferson.edu) Other reports show the field is still built mostly on unusual cases. A 2023 Korean case report described complete remission after radiotherapy, atezolizumab-bevacizumab, and surgery for peritoneal seeding, while a 2021 Japanese case report described 11-year survival in a woman with ovarian and peritoneal metastases treated over time with surgery and systemic therapy. (e-jlc.org) (europepmc.org) So the story here is not a new drug approval or a trial result. It is a documented case in which tissue removed after treatment showed no remaining tumor, in one of the rarest and hardest-to-treat patterns of liver cancer spread. (jdc.jefferson.edu)
