case_images: PMC10413100_01
case_images: Tumor responses after therapy. (A) Timeline of disease status and corresponding treatment regimens. (B) Time line of treatments of the patient and changes in MRI and CT of the liver and lung during treatments, the red circle location of the tumors.
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case_images: Cooperative Oncology Group (ECOG) performance status score of 1. CT scan showed occupying lesion in the right lobe of the liver, and multiple small nodules in both lungs. Combined with an extremely high serum alpha-fetoprotein (AFP) level (461.48 ng/ml), the patient was diagnosed with primary hepatocellular carcinoma and lung metastasis (stage IIIb, CNLC stage, Child-Pugh A with 6 points) ( Figures 1 ,  2 ).
case_images: Changes in important indicators during the course of the disease. (A) Changes in level of tumor marker AFP during treatment, the red dotted line indicated normal level. (B) Changes in level of tumor marker CA199 during treatment, the red dotted line indicated normal level. (C) Changes in levels of liver function during treatment, the dotted lines indicated normal level. (D) Changes in numbers of immune cells during treatment; medical reference range: CD3+ T, 723-2737/muL; CD4+ T, 404-1612/muL; CD8+ T, 220-1129/muL; CD19+ B, 80-616/muL; NK, 84-724/muL; NKT, 40-300/muL.
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case_images: AFP and CA199, as well as liver function indexes, returned to normal level ( Figure 2A-C ). At present, few reports on peripheral immune cells in the early stage of immunotherapy have been found. This may clarify the role of humoral immunity in response to cancer cells ( Figure 2D ).
case_images: PMC10413100_02
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case_images: PMC10413100_04
case_images: Changes in important indicators during the course of the disease. (A) Changes in level of tumor marker AFP during treatment, the red dotted line indicated normal level. (B) Changes in level of tumor marker CA199 during treatment, the red dotted line indicated normal level. (C) Changes in levels of liver function during treatment, the dotted lines indicated normal level. (D) Changes in numbers of immune cells during treatment; medical reference range: CD3+ T, 723-2737/muL; CD4+ T, 404-1612/muL; CD8+ T, 220-1129/muL; CD19+ B, 80-616/muL; NK, 84-724/muL; NKT, 40-300/muL.
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case_images: AFP and CA199, as well as liver function indexes, returned to normal level ( Figure 2A-C ). At present, few reports on peripheral immune cells in the early stage of immunotherapy have been found. This may clarify the role of humoral immunity in response to cancer cells ( Figure 2D ).
case_images: Significantly enriched KEGG pathway terms by analyzing mutated genes in the patient.
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case_images: Moreover, 8 mutated genes (APC, AXIN2, CDKN1A, EGFR, PIK3CA, PTEN, TCF7L2 and TP53) significantly relating to the hepatocellular carcinoma pathway were identified ( Figure 3 ).
case_images: PMC10413100_05
case_images: The patient developed grade 2 RCCEP after Camrelizumab treatment. (A, B) the patient appeared grade 2 RCCEP; (C) RCCEP was improved after drug withdrawal.
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case_images: Figure 4 ). Afterward, the patient accepted oral androtinib hydrochloride capsules with 8 mg qd d1-14 in 21-day cycles. Fortunately, lesions in the liver and lung of the patient showed significant complete response (CR), and the ECOG performance status score was 1.