A Case Achieving Partial Response of Lymph Node Metastasis by Combination Treatment of Radiotherapy and Third Line Regorafenib after Two-year Completion of Atezolizumab Plus Bevacizumab Therapy

Recently, the survival benefit of immuno-oncologic (IO) agents for advanced hepatocellular carcinoma (HCC) has been proven in several randomized controlled trials. Especially, atezolizumab with bevacizumab (Ate+Beva), as a first-line therapy for advanced HCC, has shown outstanding efficacy in the IMBrave150 study. Fortunately in south Korea, the cost of Ate+Beva therapy can be covered by national medical insurance, therefore HCC patients can receive Ate+Beva therapy without trouble. However, almost all HCC patients have no choice but to stop the treatment after two years completion of Ate+Beva therapy because our national medical insurance only cover IO therapy for two years. Therefore clinicians have been restarting the systemic treatment after confirming the disease progression of HCC patients on resting period of systemic therapy. Here, we report a case that showed a partial response of lymph node metastasis by 3rd line regorafenib therapy for progression of LN metastasis after achieving nearly complete response by two-year completion of 1st line Ate+Beva therapy in advanced HCC patient.