Skip to main content

Advertisement

SpringerLink
Log in

Complete tumor necrosis confirmed by conversion hepatectomy after atezolizumab–bevacizumab treatment for advanced-stage hepatocellular carcinoma with lung metastasis

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

A combined therapy of atezolizumab and bevacizumab (atezo/bev) is used as the first-line treatment for unresectable hepatocellular carcinoma (HCC). In this study, we report the case of curative hepatic resection in a 77-year-old man who initially had unresectable advanced-stage HCC with lung metastases. This rare hepatectomy conversion was owing to the administration of atezo/bev. Notwithstanding the side effects of immune-related adverse event hepatitis and intratumoral hemorrhage developed during atezo/bev treatment; after seven treatment cycles, the patient’s tumor markers normalized, the tumor shrank markedly, and the metastasis disappeared. Subsequently, conversion therapy with hepatic resection was performed, and pathology confirmed complete tumor necrosis. No cancer recurrence was observed at the 8-month postoperative follow-up, and the patient remained drug free.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated or analyzed in the present study are available from the corresponding author on reasonable request.

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  PubMed  Google Scholar 

  2. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76:681–93.

    Article  PubMed  Google Scholar 

  3. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020;382:1894–905.

    Article  CAS  PubMed  Google Scholar 

  4. Kudo M. A novel treatment strategy for patients with intermediate-stage HCC who are not suitable for TACE: upfront systemic therapy followed by curative conversion. Liver Cancer. 2021;10:539–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hayakawa Y, Tsuchiya K, Kurosaki M, et al. Early experience of atezolizumab plus bevacizumab therapy in Japanese patients with unresectable hepatocellular carcinoma in real-world practice. Invest New Drugs. 2022;40:392–402.

    Article  CAS  PubMed  Google Scholar 

  6. Xu S, Lai R, Zhao Q, et al. Correlation between immune-related adverse events and prognosis in hepatocellular carcinoma patients treated with immune checkpoint inhibitors. Front Immunol. 2021;12: 794099.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Li P, Liang Y, Zeng B, et al. Preoperative prediction of intra-tumoral tertiary lymphoid structures based on CT in hepatocellular cancer. Eur J Radiol. 2022;151: 110309.

    Article  PubMed  Google Scholar 

  8. Wang Y, Lu LC, Guan Y, et al. Atezolizumab plus bevacizumab combination enables an unresectable hepatocellular carcinoma resectable and links immune exclusion and tumor dedifferentiation to acquired resistance. Exp Hematol Oncol. 2021;10:45.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hoshino T, Naganuma A, Furusawa A, et al. A case of conversion hepatectomy for huge hepatocellular carcinoma with adrenal metastasis and vascular invasion after atezolizumab-bevacizumab treatment. Clin J Gastroenterol. 2022;15:776–83.

    Article  PubMed  Google Scholar 

  10. Hidaka Y, Tomita M, Desaki R, et al. Conversion surgery for hepatocellular carcinoma with portal vein tumor thrombus after successful atezolizumab plus bevacizumab therapy: a case report. World J Surg Oncol. 2022;20:228.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan

    Atsushi Fukunaga, Kazuhide Takata, Ryo Yamauchi, Takashi Tanaka, Keiji Yokoyama, Satoshi Shakado & Fumihito Hirai

  2. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Shinji Itoh & Tomoharu Yoshizumi

  3. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kenichi Kohashi

Authors
  1. Atsushi Fukunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuhide Takata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shinji Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryo Yamauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keiji Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Satoshi Shakado
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenichi Kohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoharu Yoshizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fumihito Hirai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuhide Takata.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was given by the patient for the publication of this manuscript. Identifying information, aside from age and sex, was removed and the images provided were anonymized to protect patient confidentiality.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukunaga, A., Takata, K., Itoh, S. et al. Complete tumor necrosis confirmed by conversion hepatectomy after atezolizumab–bevacizumab treatment for advanced-stage hepatocellular carcinoma with lung metastasis. Clin J Gastroenterol 16, 224–228 (2023). https://doi.org/10.1007/s12328-022-01744-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-022-01744-z

Keywords

Search

Navigation