Introduction: Hepatocellular carcinoma (HCC) is a highly malignant tumor around the world, the most frequent site of extrahepatic metastasis in HCC patients is the lungs, and snlotinib is a novel oral oral multi-targeted receptor tyrosine kinase inhibitor that is synthetized to primarily inhibit a group of newly identified kinase, such as VEGFR2/3,FGFR1-4,PDGFR ?/?, which plays an important role in tumor progression. It has been approved for treatment of advanced none-small cell lung cancer, small cell lung cancer, soft tissue sarcoma in China. Here we discuss a case of anlotinib for the treatment of advanced hepatocellular carcinoma with lung metastasis. Case Report: The patient is a 56-year-old man with a history of chronic hepatitis B and 40 years drinking history. He presented with a detectable liver lesion which was clinically diagnosed as HCC in September 2014, after surgery for hepatocellular carcinoma, he was found left lung metastases in 2015. Then the patient was suggested to take Sorafenib until 2018, after the new lesion be found in the right lung, he was treated with nivolumab 140 mg PD-1 immunotherapy checkpoint inhibitor for four cycles. After the failure of nivolumb, he received the combination of PD-1 nivolumab 140 mg and CTLA-4 ipilimumab 46 mg q2w for four cycles. But the patient couldn???t acquire benefits from dual-immune checkpoint inhibition, then the patient was given oral anlotinib 10 mg d1-14 q3w from October 2018. The CT scan performed after anlotinib therapy 1 cycle (21 days), exhibited that the lesions in the lung were much smaller, the patient was determined to have partial response. The progression-free survival time is 7 months, at last, the patient died for the pulmonary infection on April 2019. Discussion: There are no specific treatment options for hepatocellular carcinoma with lung metastasis other than the recommendations under guidelines for advanced HCC. We found that the anlotinib for the lung metastasis with HCC showed excellent efficacy. Anlotinib extended the life expectancy significantly for this patient. To the best of our knowledge, this is the first case report of anlotinib in the treatment of HCC with lung metastasis.
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