An Effective Case of Radiofrequency Ablation with the Combination of Durvalumab and Tremelimumab Treatment for Hepatocellular Carcinoma

Recent advances in immune checkpoint inhibitors (ICIs) have improved the survival of patients with hepatocellular carcinoma (HCC). However, the therapeutic efficacy is influenced by the tumor immune phenotype. We report the case of a 77-year-old man with advanced HCC who was treated with durvalumab plus tremelimumab. Although radiologic imaging showed tumor shrinkage and normalized serum tumor marker levels, contrast-enhanced ultrasound identified residual hypervascular lesions. A biopsy revealed scarce intratumoral lymphocytes, suggesting a cold tumor phenotype. Sequential radiofrequency ablation (RFA) was performed, resulting in a complete response according to the modified RECIST. This case highlights that cold tumors may persist despite an apparent regression, and suggests that combining RFA with ICIs may enhance antitumor immunity and improve treatment outcomes.