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CASE REPORT

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

Laith Al-Showbaki1 ,  Aseel Ghanayem2* ,  Batool Hyari2 ,  Ammar M. Bashtawi1 ,  Husam Abuawad3
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1 Division of Hematology and Medical Oncology, Department of Medicine, Jordan University Hospital and School of Medicine, the University of Jordan, Amman, Jordan
2 Department of Medicine, School of Medicine, The University of Jordan, Amman, Jordan
3 Department of Pathology, Jordan University Hospital, Amman, Jordan
CP, 5382
Submitted: 21 October 2024 | Revised: 15 February 2025 | Accepted: 17 February 2025 | Published: 6 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

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.

Keywords
Fibrolamellar carcinoma
Hepatocellular carcinoma
Immune checkpoint inhibitors
Folinic acid
Fluorouracil
Oxaliplatin
Folinic acid
Fluorouracil
Irinotecan
Lenvatinib
Funding
None.
Conflict of interest
The authors declare that the research was concluded in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.
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