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Ishihara N, Komatsu S, Kido M, Gon H, Fukushima K, Urade T, Yoshida T, Arai K, Yanagimoto H, Toyama H, Fukumoto T. Complete response to tremelimumab plus durvalumab treatment in hepatocellular carcinoma with a bile duct tumor thrombus: A case report. Oncol Lett 2024; 28:332. [PMID: 38807678 PMCID: PMC11130751 DOI: 10.3892/ol.2024.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/05/2024] [Indexed: 05/30/2024] Open
Abstract
Tremelimumab plus durvalumab (Dur/Tre) is the first-line treatment for advanced hepatocellular carcinoma (HCC) worldwide. The present report describes the case of a 68-year-old man diagnosed with advanced HCC and a bile duct tumor thrombus (BDTT) who achieved a complete response to Dur/Tre therapy. The BDTT progressed to the bifurcation of the left and right hepatic ducts. Over time, both the tumors and BDTT progressively decreased in size, and a complete response was confirmed using the Response Evaluation Criteria in Solid Tumors (version 1.1.) 6 months after treatment administration. Subsequently, immune-related adverse events, including type 1 diabetes mellitus and diabetic ketoacidosis, emerged, leading to treatment discontinuation. The patient was undergoing outpatient follow-up in a drug-free state with no signs of recurrence 290 days after the initial administration of Dur/Tre. Although long-term and meticulous observations are required, the present findings could influence the choice of systemic chemotherapy for advanced HCC.
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Affiliation(s)
- Nobuaki Ishihara
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Kenji Fukushima
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Toshihiko Yoshida
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Keisuke Arai
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
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Hong ZH, Dickey M, Wong P, Gasper H. An extraordinary response to dual immune checkpoint inhibitor and vascular endothelial growth factor inhibition in a patient with hepatocellular carcinoma and follicular lymphoma. Intern Med J 2023; 53:1085-1086. [PMID: 37349278 DOI: 10.1111/imj.16116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Zhen H Hong
- Cancer Care Darling Downs Hospital and Health Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Marcus Dickey
- Cancer Care Darling Downs Hospital and Health Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Philip Wong
- Cancer Care Darling Downs Hospital and Health Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Harry Gasper
- Cancer Care Darling Downs Hospital and Health Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
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Pentapati S, Caucci S, Balmuri S, Devarkonda V. Complete Remission of Advanced Hepatocellular Carcinoma in a Patient With Ulcerative Colitis Treated With Atezolizumab and Bevacizumab: A Case Report. Cureus 2023; 15:e39538. [PMID: 37366434 PMCID: PMC10290901 DOI: 10.7759/cureus.39538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
In this case study, a 73-year-old man who had previously undergone colectomy had a history of ulcerative colitis and alcohol abuse and presented with fatigue, weight loss, and a liver lesion. After a biopsy, he was diagnosed with stage IV-A hepatocellular carcinoma with poor differentiation and cirrhotic architecture, and molecular testing revealed positivity for multiple genes. A combination of atezolizumab and bevacizumab was administered, resulting in complete remission lasting beyond 16 months, demonstrating the potential of these drugs as a treatment option for advanced hepatocellular carcinoma (HCC). The patient's history of autoimmune conditions could have contributed to his robust response to the treatment. The report highlights the sustained survival benefits of this treatment beyond month 16.
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Affiliation(s)
- Swetha Pentapati
- Hematology and Oncology, Michigan State University College of Human Medicine, Lansing, USA
| | - Stephen Caucci
- Internal Medicine, Michigan State University College of Human Medicine, Lansing, USA
| | - Shravya Balmuri
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Vishal Devarkonda
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
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Hidaka Y, Tomita M, Desaki R, Hamanoue M, Takao S, Kirishima M, Ohtsuka T. 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. [PMID: 35831894 PMCID: PMC9277871 DOI: 10.1186/s12957-022-02691-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/30/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The treatment of hepatocellular carcinoma (HCC) requires diverse and multidisciplinary approaches. In recent years, new agents with good antitumor effects have emerged for systemic chemotherapy, and conversion surgery (CS) after systemic chemotherapy is expected to be an effective treatment strategy for unresectable HCC. We herein report a case of unresectable HCC with portal vein tumor thrombus (PVTT) in which atezolizumab plus bevacizumab therapy induced PVTT regression, followed by CS with R0 resection. CASE PRESENTATION The patient was a 79-year-old man with S2/S3 HCC who was referred to our department due to tumor re-growth and PVTT after two rounds of transcatheter arterial chemoembolization. The PVTT extended from the left portal vein to the main trunk, and it was determined that the resection of the left portal vein would be difficult to perform with R0 status. Based on the diagnosis of unresectable HCC, treatment with atezolizumab plus bevacizumab was initiated. After two courses of treatment, contrast-enhanced computed tomography showed that the PVTT had regressed to the peripheral side of the left portal vein, and R0 resection became possible. The patient developed grade 3 skin lesions as an immune-related adverse event, and it was determined that the continuation of chemotherapy would be difficult. Four weeks after the second course of atezolizumab plus bevacizumab administration, left lobectomy was performed. Intraoperative ultrasonography was used to confirm the location of the tumor thrombus in the left portal vein during the resection, and a sufficient surgical margin was obtained. The histopathological findings showed that primary tumor and PVTT were mostly necrotic with residues of viable tumor cells observed in some areas. The liver background was determined as A1/F4 (new Inuyama classification). The resection margins were negative, and R0 resection was confirmed. There were no postoperative complications. No recurrence was observed as of five months after surgery. CONCLUSIONS CS with atezolizumab plus bevacizumab therapy has potential utility for the treatment of unresectable HCC with PVTT.
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Affiliation(s)
- Yoshifumi Hidaka
- Department of Surgery, Tanegashima Medical Center, 7463 Nishinoomote, Nishinoomote, Kagoshima, 891-3198, Japan.
| | - Miyo Tomita
- Department of Surgery, Tanegashima Medical Center, 7463 Nishinoomote, Nishinoomote, Kagoshima, 891-3198, Japan
| | - Ryosuke Desaki
- Department of Surgery, Tanegashima Medical Center, 7463 Nishinoomote, Nishinoomote, Kagoshima, 891-3198, Japan
| | - Masahiro Hamanoue
- Department of Surgery, Tanegashima Medical Center, 7463 Nishinoomote, Nishinoomote, Kagoshima, 891-3198, Japan
| | - Sonshin Takao
- Department of Surgery, Tanegashima Medical Center, 7463 Nishinoomote, Nishinoomote, Kagoshima, 891-3198, Japan
| | - Mari Kirishima
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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