Heterogenous responses to nivolumab in a single metastatic nodule in hepatocellular carcinoma: role of salvage surgery

A recent report demonstrated immune heterogeneity of hepatocellular carcinoma (HCC) (1). The objective response rates of sorafenib-treated global and Asian patients by nivolumab, the monoclonal antibody to programmed cell death protein-1, were only 14% and 15%, respectively (2,3). However, there is a lack of reports demonstrating the heterogenous responses within single tumor to nivolumab. Here, we show a pathologically confirmed, heterogenous response to nivolumab within a single metastatic tumor from HCC. In these circumstances, surgery can be considered as an option to cure the disease.