J Liver Cancer.  2022 Mar;22(1):69-74. 10.17998/jlc.2022.03.09.

Concurrent transarterial radioembolization and combination atezolizumab/ bevacizumab treatment of infiltrative hepatocellular carcinoma with portal vein tumor thrombosis: a case report

• Park MK
• Yu SJ

• KMID: 2528299
• DOI: http://doi.org/10.17998/jlc.2022.03.09

Abstract

Treatment options for advanced hepatocellular carcinoma (HCC) have been rapidly evolving. Herein, we describe a patient with advanced HCC and portal vein tumor thrombosis (PVTT) who responded decisively to a multidisciplinary approach. The patient had an ill-defined infiltrative HCC (diffuse subtype), with several intrahepatic metastasis and tumor invasion of left portal vein. Concurrent use of transarterial radioembolization (TARE) and systemic therapeutics (atezolizumab + bevacizumab) ultimately proved successful. There was marked reduction in tumor volume after TARE and an additional three cycles of atezolizumab plus bevacizumab. This concurrent treatment was well tolerated, without adverse events during immunotherapy. The impressive results achieved suggest that concurrent TARE and combination atezolizumab/bevacizumab is a promising treatment approach for advanced HCC with PVTT.

Keyword

Hepatocellular carcinoma; Radioembolization; Immune checkpoint inhibitors; Case reports

Figure

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  Figure 1 Initial dynamic magnetic resonance imaging study of liver: (A) large infiltrative hepatocellular carcinoma, enhanced on arterial phase; (B) washout on portal phase; (C–E) multiple intrahepatic metastases (arrows); and (F) prominent lymph node at common hepatic artery (arrow).

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  Figure 2 Follow-up dynamic computed tomography of liver after transarterial radioembolization and third cycle of atezolizumab/bevacizumab: (A–C) regression of infiltrative hepatocellular carcinoma; and (D) similar-sized lymph node.

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  Figure 3 Follow-up dynamic computed tomography of liver after sixth cycle of atezolizumab/bevacizumab: (A, B) suspicious new intrahepatic lesions; (C) further regression of infiltrative hepatocellular carcinoma; and (D) nodal enlargement (common hepatic artery).

Reference

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