Metastatic fibrolamellar hepatocellular carcinoma in the immune checkpoint and multikinase inhibitor era: A case report

Fibrolamellar carcinoma (FLC) is a rare liver cancer that predominantly affects young adults without liver disease. Its typical symptoms include abdominal pain, palpable mass, and/or generalized signs such as weight loss and fatigue. Although patients with localized FLC frequently experience favorable outcomes after surgical resection, the recurrence rate is high. For patients with metastatic or unresectable FLC, alternative treatments such as chemotherapy and radiation are considered; however, standardized treatment protocols remain scarce. This case report describes a 24-year-old man with de novo metastatic FLC and peritoneal involvement. The patient was administered various therapies, including atezolizumab and bevacizumab combination therapy; lenvatinib, folinic acid, fluorouracil, oxaliplatin; and folinic acid, fluorouracil, irinotecan plus bevacizumab. The response to each regimen varied, ranging from initial response followed by disease progression to no response at all. Although metastatic FLC is an uncommon disease, it presents a substantial challenge to patients and healthcare professionals due to the absence of well-established guidelines. In addition to numerous published cases, this case report may offer clinicians valuable insights into the management of FLC.