Hepatic artery infusion chemotherapy for advanced hepatocellular carcinoma with obstructive jaundice: A case report and review of literature

BACKGROUND: Hepatocellular carcinoma (HCC) is a major type of liver cancer worldwide. In advanced stages, portal vein tumor thrombosis (PVTT) and jaundice are common, whereas obstructive jaundice (OJ) is relatively rare. Both conditions markedly reduce survival and increase therapeutic complexity. Recently, hepatic artery infusion chemotherapy (HAIC) in combination with targeted immunotherapy has shown promise for advanced HCC. CASE SUMMARY: We report a 47-year-old male with advanced HCC complicated by PVTT and OJ, who was admitted with marked jaundice of the skin and sclera. Imaging revealed a large hepatic mass (14.5 cm × 11.3 cm) in the right lobe with associated portal vein tumor thrombus. The tertiary bile duct was only mildly dilated, making percutaneous transhepatic cholangiography drainage infeasible. The patient underwent reduced-dose HAIC, which resulted in significant tumor shrinkage and marked reduction in serum bilirubin. This improvement enabled sequential treatment with lenvatinib and camrelizumab. After six cycles, both liver function and alpha-fetoprotein levels improved. The patient achieved a progression-free survival of 20 months and an overall survival of 29 months. CONCLUSION: HAIC can treat high-bilirubin HCC with PVTT and OJ, allowing for subsequent targeted immunotherapy.