Fig. 1.

Tumor control by the reintroduction of lenvatinib. The sacral metastasis was irradiated (30 Gy/10 frequencies) on October 10, 2018. After this, lenvatinib 12 mg/day was given on November 29, 2018. A partial response was noticed probably by radiation therapy, but tumor progression was observed in July 2019. The patient received pembrolizumab on July 22, 2019, because of the microsatellite instability-high phenotype confirmed by the MSI detection test (FALCO Biosystems, Kyoto, Japan). Pembrolizumab was discontinued on October 28, 2019, because of the rapid tumor growth and increased AFP levels, accompanied by exacerbation of rectal and bladder disturbance. Lenvatinib 12 mg/day was reintroduced on November 18, 2019, leading to a rapid decrease in serum AFP level. On December 23, 2019, serum AFP was reduced to the normal level with a significant decrease in FDG uptake in the metastatic lesion, shown by positron emission tomography-CT on January 29, 2020. AFP, alpha-fetoprotein; FDG, fluorodeoxyglucose.