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A case of hepatocellular carcinoma with “pseudoprogression” followed by complete response to atezolizumab plus bevacizumab

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Abstract

Atezolizumab plus bevacizumab (Atezo + Bev) is the first immunotherapy for hepatocellular carcinoma (HCC), and in the current guidelines, it is positioned as the first-line chemotherapy for unresectable cases. Herein, we report a case of HCC with pseudoprogression followed by a complete response to Atezo + Bev. A 56 year-old man was diagnosed with intermediate-stage HCC, as defined by the Barcelona Clinic Liver Cancer system stage B. Computed tomography (CT) revealed multiple lesions in the liver without any extrahepatic lesions. First, he was treated with transcatheter arterial chemoembolization (TACE); however, multiple residual lesions were observed on CT scan 2 months after TACE. Therefore, treatment with Atezo + Bev was initiated 4 months after TACE. After the third administration of Atezo + Bev, a CT scan showed progressive disease in intrahepatic lesions, along with increased serum levels of tumor markers. Although TACE was planned again, Atezo + Bev was continued while the patient was waiting for hospitalization. After the fifth administration of Atezo + Bev, serum levels of tumor markers decreased to the normal range. Magnetic resonance imaging showed prominently reduced tumor size. Therefore, Atezo + Bev was continued, and after the eighth administration, the CT scan showed the disappearance of all the liver lesions, indicating a complete response. In immunotherapy, the therapeutic response can sometimes be obtained in an atypical pattern due to either an increase in tumor burden or the appearance of new lesions, called “pseudoprogression,” which is rare in HCC.

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Authors and Affiliations

  1. Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan

    Naoshi Odagiri, Kohei Kotani, Hiroyuki Motoyama, Etsushi Kawamura, Atsushi Hagihara, Hideki Fujii, Masaru Enomoto & Norifumi Kawada

  2. Department of Internal Medicine, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan

    Akihiro Tamori

  3. Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan

    Sawako Uchida‑Kobayashi

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  1. Naoshi Odagiri
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  2. Akihiro Tamori
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  3. Kohei Kotani
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Correspondence to Akihiro Tamori.

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Odagiri, N., Tamori, A., Kotani, K. et al. A case of hepatocellular carcinoma with “pseudoprogression” followed by complete response to atezolizumab plus bevacizumab. Clin J Gastroenterol 16, 392–396 (2023). https://doi.org/10.1007/s12328-023-01761-6

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  • DOI: https://doi.org/10.1007/s12328-023-01761-6

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