title: Therapeutic response of untreatable hepatocellular carcinoma after application of the immune modulators IL-2, BCG and melatonin.
abstract: OBJECTIVE
  Application of immunotherapy to a patient with untreatable hepatocellular carcinoma.
  
  
  METHODS
  The patient had a tumor of 60 mm in the liver. The pathological anatomic diagnosis was adenoma. However, after surgery of the tumor seven new lesions arose, showing that the original tumor had been a hepatocellular carcinoma. In addition, when hepatocellular adenomas grow to a size of more than 6-8 cm, they are considered cancerous and thus become a risk for hepatocellular carcinoma. The patient was treated with interleukin-2, Bacillus Calmette Guerin, and melatonin.
  
  
  RESULTS
  During treatment, the alpha-fetoprotein levels in blood fell from 5,000 IU/ml to zero, at which level it remained during the follow-up period of two years. No tumor was detectable on MRI and CT. Six years after the diagnosis of untreatable hepatocellular carcinoma, the patient remains in a good condition.
  
  
  CONCLUSIONS
  In this case, combined immunomodulating therapy was effective. For patients with metastasized tumors of the liver who are not suitable for conventional therapy, immunomodulation may delay tumor progression, induce tumor regression, or even be curative in some patients. Immunotherapeutic approaches combined with conventional methods for hepatocellular carcinoma treatment may be able to improve therapeutic efficacy.
authors.affiliation: Department of Urology, VUmc, Amsterdam, the Netherlands. W.denotter@VUmc.nl; W.den.otter@live.nl.
authors.forename: Bojidar
authors.initials: B
authors.lastname: Tomov
authors.forename: Dimitar
authors.initials: D
authors.lastname: Popov
authors.forename: Radosveta
authors.initials: R
authors.lastname: Tomova
authors.forename: Nicola
authors.initials: N
authors.lastname: Vladov
authors.forename: Willem
authors.initials: W
authors.lastname: Den Otter
authors.forename: Zachary
authors.initials: Z
authors.lastname: Krastev
mesh_terms: D000368:Aged; D001500:BCG Vaccine / Q000276:immunology / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007167:Immunotherapy; D007376:Interleukin-2 / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy; D008550:Melatonin / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D001500:BCG Vaccine; D007155:Immunologic Factors; D007376:Interleukin-2; D000509:alpha-Fetoproteins; D008550:Melatonin
keywords: BCG; HCC; Hepatocellular carcinoma; IL-2; immunotherapy; interleukin-2; melatonin