Case Report: Tumor regression and neurological recovery in paraplegia from POLD1-mutated hepatocellular carcinoma treated with targeted immunotherapy and electroacupuncture

BackgroundHepatocellular carcinoma (HCC) patients with bone metastasis-induced paraplegia have an extremely poor prognosis. The potential for neurological recovery following immunotherapy and subsequent rehabilitation in this population remains unclear.CaseA 58-year-old male with Barcelona Clinic Liver Cancer stage C (BCLC) HCC and T11 vertebral metastasis causing American Spinal Injury Association (ASIA) grade C paraplegia carried a rare POLD1 c.1745C>T (p.T582M) germline mutation with low tumor mutational burden (TMB) and microsatellite instability-low status (MSI-L, blood-based MSI-L (bMSI-L) 7.76%).

Immunotherapy with atezolizumab (1200 mg every 3 weeks [Q3W]) combined with targeted therapy with bevacizumab (600 mg Q3W) was initiated in July 2021.A substantial temporal gap of approximately 21 months followed, after which electroacupuncture-based rehabilitation (5-Hz continuous-wave, stimulating Jiaji acupoints, Zusanli, etc) was started in May 2023.ResultsFollowing three months of targeted immunotherapy, the tumor exhibited complete response (CR) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). At the 28-month follow-up assessment, the patient was eventually able to walk independently with a walker.