Complete response to fourth-line nivolumab in metastatic hepatocellular carcinoma: A case report

Hepatocellular carcinoma (HCC) is an important cause of cancer-related mortality, and systemic therapies have historically provided only limited benefit. While immune checkpoint inhibitors (ICIs) have reshaped treatment strategies in HCC, durable complete responses with nivolumab monotherapy are rare. We describe a 71-year-old male with HCC related to hepatitis B virus (HBV) who failed multiple systemic therapies including capecitabine, sorafenib, and regorafenib. Nivolumab was initiated in December 2019, and complete remission was achieved within three months of treatment. The patient maintained a complete response for over six years without significant immune-related toxicity. This case demonstrates the potential of achieving exceptional and durable efficacy with nivolumab monotherapy in advanced HCC, even in patients previously treated with several lines of systemic treatment.