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A successful case of transarterial chemoembolization for hyperprogressive disease induced by immunotherapy in a patient with unresectable hepatocellular carcinoma

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Abstract

A fraction of patients with hepatocellular carcinoma (HCC) shows unexpected rapid tumor growth, called hyperprogressive disease (HPD) after the initiation of atezolizumab and bevacizumab (ATZ + BEV). However, little information is available concerning salvage therapy after HPD and the possibility of resuming ATZ + BEV. A 60-year-old woman with unresectable HCCs was treated with transarterial chemoembolization (TACE) and followed by lenvatinib, which showed an unsatisfactory result. Multiple HCCs had been noted in both lobes just before ATZ + BEV treatment. After the initiation of ATZ + BEV, a tumor in the left lobe grew rapidly. The tumor growth kinetics ratio and tumor growth rate ratio of the rapidly growing lesion were 3.76 and 2.02, respectively. Thyroid dysfunction was noted after the initiation of ATZ + BEV. The neutrophil/lymphocyte ratios just before and at 3 weeks after the first ATZ + BEV treatment were 3.89 and 3.5, respectively. Drug-eluting bead (DEB)-TACE using cisplatin was performed for the rapidly growing tumor, which was effective for the targeted HCC in the left lobe as well as multiple HCCs in the right lobe. We were able to resume and continue ATZ + BEV without HPD, which was effective for HCC. We considered that DEB-TACE is an option for treating HPD.

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Oyunjargal Baterdene, Kouichi Miura, Wataru Ueno, Shunji Watanabe, Mamiko Tsukui, Hiroaki Nomoto, Rie Goka, Hiroshi Maeda, Hironori Yamamoto & Naoki Morimoto

Authors
  1. Oyunjargal Baterdene
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  2. Kouichi Miura
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  3. Wataru Ueno
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  4. Shunji Watanabe
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  5. Mamiko Tsukui
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  6. Hiroaki Nomoto
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  7. Rie Goka
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  8. Hiroshi Maeda
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  9. Hironori Yamamoto
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  10. Naoki Morimoto
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Contributions

Study design and concept: OB, KM, and NM. Data acquisition: OB, KM, WU, SW, MT, HN, RG, HM, HY, and NM. Drafting manuscript: OB and KM. Critical Revision of the manuscript and supervision: HY and NM. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kouichi Miura.

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Conflict of interest

N. M received honoraria from Chugai Pharmaceutical Co., Ltd. and Eisai Co., Ltd. and scholarship grants from Eisai Co., Ltd. H.Y received scholarship grants from Nippon Kayaku. Other authors declare no competing interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient for being included in the study.

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Baterdene, O., Miura, K., Ueno, W. et al. A successful case of transarterial chemoembolization for hyperprogressive disease induced by immunotherapy in a patient with unresectable hepatocellular carcinoma. Clin J Gastroenterol 15, 1101–1107 (2022). https://doi.org/10.1007/s12328-022-01697-3

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  • DOI: https://doi.org/10.1007/s12328-022-01697-3

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