Elderly patient with unresectable advanced‑stage hepatocellular carcinoma who received atezolizumab plus bevacizumab and achieved a complete response: A case report

Abstract

Hepatocellular carcinoma (HCC) is a common malignancy with a poor prognosis, particularly in patients with advanced-stage disease, elderly individuals and/or in those with poor liver function. Immune checkpoint inhibitor-containing therapies, such as atezolizumab, an anti-programmed death ligand-1 monoclonal antibody, plus bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, may be effective and safe therapeutic options for elderly patients with advanced-stage HCC. The present study reports the case of a male patient his 80s who consumed alcohol with unresectable advanced-stage HCC who received combination therapy comprising atezolizumab plus bevacizumab for 6 months. The patient achieved a complete response despite the discontinuation of treatment due to nephrotoxicity. It is critical for patients with HCC and a Child-Pugh A grade to continue therapy for HCC, even if they are older. The development of more effective therapies is required for patients with advanced-stage HCC with a worse liver function than those with a Child-Pugh A grade. The case described in the present study demonstrates the need for obtaining further evidence regarding the efficacy and safety of the combination therapy including atezolizumab plus bevacizumab for elderly patients with advanced-stage HCC.

Keywords: complete response; liver cancer; older patient; stage IV disease; systemic therapy.

Figure 1

Changes in abdominal CT scan images obtained during combination therapy with atezolizumab plus bevacizumab. (A-C) Prior to therapy, a CT scan demonstrated multiple hepatocellular carcinomas in the liver and swelling of the lymph nodes in the paraaortic lesion and other sites. (D-F) After 5 months of combination therapy, a CT scan demonstrated the disappearance of any intratumoral arterial enhancement in any of the target lesions. (G-I) At 4 months after the combination treatment was suspended, a CT scan did not demonstrate any recurrences. CT, computed tomography.

Figure 2

Clinical course and changes in tumor markers in hepatocellular carcinoma in the case described herein. At 5 months after the commencement of combination therapy comprising atezolizumab and bevacizumab, the tumor marker levels of the patient returned to within normal limits. AFP, α-fetoprotein; AFP-L3, lectin-reactive profile of AFP; PIVKA-II, protein induced by vitamin K absence or antagonist II. The black arrows indicate the time points of single combination therapy with atezolizumab and bevacizumab.