BACKGROUND: Hepatocellular carcinoma (HCC) is the fourth most common cancer in the Philippines and is the second leading cause of cancer-related death due to advanced stage at diagnosis in many patients. Advanced HCC commonly has macrovascular invasion such as portal and hepatic veins however, cases that describe tumor extension into the inferior vena cava (IVC) and right atrium (RA) are rare. CASE SUMMARY: We present a case of a 50-year old female with liver cirrhosis from Chronic Hepatitis B infection who presented with shortness of breath. She was diagnosed with HCC based on dynamic enhancement pattern on CT scan with IV contrast and highly elevated alpha- fetoprotein. CT imaging demonstrated hepatic vein invasion with large tumor thrombus extending to the inferior vena cava and right atrium. Patient also had a mild COVID infection. We treated her with modulated radiotherapy targeting the tumor thrombus along with lenvatinib, tenofovir, and apixaban. The COVID infection did not significantly affect the patient's over-all clinical status. CONCLUSION Vascular invasion of HCC into the IVC and RA portends poor prognosis. While there is no consensus on the intervention on these patients, our case may suggest the use of radiotherapy and oral anticoagulation along with lenvatinib to prolong survival and preserve quality of life.

BACKGROUND/AIMS: Hepatitis C virus (HCV) replicates in the peripheral blood mononuclear cells (PBMCs), leading to the production of type I interferons (IFNs). It is well known that the gene expression profile of PBMC is similar to that of the liver. The present study explored the dynamic gene expression profile of PBMCs collected from HCV-infected patients undergoing direct-acting antiviral (DAA) therapy. METHODS: A prospective cohort comprising 27 patients under DAA therapy was formed. Expression level of IFN-β and its downstream interferon-stimulated genes (ISGs) was measured in PBMCs before and after DAA treatment. Furthermore, immunoblotting was performed to identify the signaling molecules involved in the expression of ISGs. RESULTS: The pretreatment expression level of interferon-induced protein 44 (IFI44) and C-X-C motif chemokine ligand 10 (CXCL10) correlated with the pretreatment expression level of IFN-β. After DAA treatment, a significant decrease in the expression levels of IFN-β, IFI44, and CXCL10 was observed in the PBMCs. Furthermore, the pretreatment expression level of IFN-β and ISGs correlated with the level of signal transducer and activator of transcription 1 (STAT1) phosphorylation, and DAA treatment abrogated STAT1 phosphorylation. CONCLUSIONS: Pretreatment activation of IFN-β response is rapidly normalized after DAA treatment. The present study suggests that the decreased type I IFN response by the clearance of HCV might contribute to DAA-induced alleviation of extrahepatic manifestation of chronic HCV infection.
Antiviral Agents ; Cohort Studies ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Immunoblotting ; Interferon Type I* ; Interferons ; Liver ; Phosphorylation ; Prospective Studies ; STAT1 Transcription Factor ; Transcriptome

BACKGROUND/AIMS: Metronomic chemotherapy (MET) is frequently administered in comparatively low doses as a continuous chemotherapeutic agent. The aim of this study was to evaluate the feasibility and overall survival (OS) of MET compared to sorafenib for advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). METHODS: A total of 54 patients with advanced HCC and PVTT who had undergone MET were analyzed between 2005 and 2013. A total of 53 patients who had undergone sorafenib therapy were analyzed as the control group. The primary endpoint of this study was OS. RESULTS: The median number of MET cycles was two (1-15). The OS values for the MET group and sorafenib group were 158 days (132-184) and 117 days (92-142), respectively (P=0.029). The Cox proportional-hazard model showed that a higher risk of death was correlated with higher serum alpha fetoprotein level (≥400 mg/dL, hazard ratio [HR]=1.680, P=0.014) and Child-Pugh class B (HR=1.856, P=0.008). CONCLUSIONS: MET was associated with more favorable outcomes in terms of overall survival than was sorafenib in patients with advanced HCC with PVTT, especially in patients with poor liver function. Therefore, MET can be considered as a treatment option in patients with advanced HCC with PVTT and poor liver function.
Administration, Metronomic ; alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Drug Therapy* ; Humans ; Liver* ; Portal Vein ; Thrombosis