Department of Gastroenterology and Metabolism, Hiroshima University, Japan.
Anatomical Pathology, Hiroshima University, Japan.
Medicine (Baltimore). 2021 Oct 22;100(42):e27576. doi: 10.1097/MD.0000000000027576.
Various treatments are available for treating hepatocellular carcinoma (HCC). The immune checkpoint inhibitor combination of atezolizumab plus bevacizumab was recently approved for the treatment of unresectable HCC, but there are few reports on the failure of the combination treatment. Here, we present a case of unresectable HCC with adrenal metastasis that was eventually operated on after lenvatinib (LEN) treatment that followed failed treatment with atezolizumab plus bevacizumab.
A 68-year-old man was diagnosed with non-alcoholic steatohepatitis-based HCC with adrenal metastasis.
Cirrhosis was classified as Child-Pugh score of 5. HCC was diagnosed as Barcelona Clinic Liver Cancer stage C.
We initiated treatment with atezolizumab plus bevacizumab. Liver dysfunction appeared 2 days after the first administration but was improved by intravenous rehydration and did not appear after the second course. The HCC shrank, but the adrenal metastasis grew bigger after the fourth course, so we changed the therapy to LEN. After HCC and adrenal metastasis were necrotic by LEN, conversion surgery was performed.
After successful conversion therapy, the general condition of the patient was good, and has been carefully followed for 4 months to date without any evidence of further recurrences.
This case showed that even if atezolizumab plus bevacizumab is not effective, multidisciplinary treatment such as LEN and conversion surgery is possible. Given the efficacy of LEN after atezolizumab plus bevacizumab, it is important to consider that there is a possibility of cure even when first-line treatment is not effective for a patient with unresectable HCC.
有多种治疗方法可用于治疗肝细胞癌（HCC）。免疫检查点抑制剂阿替利珠单抗联合贝伐珠单抗的组合最近被批准用于治疗不可切除的 HCC，但关于该联合治疗失败的报道很少。在这里，我们报告了一例不可切除的 HCC 伴肾上腺转移，在接受阿替利珠单抗联合贝伐珠单抗治疗失败后，先用仑伐替尼（LEN）治疗，然后最终进行了手术。
一名 68 岁男性被诊断为非酒精性脂肪性肝炎相关 HCC 伴肾上腺转移。
肝硬化的 Child-Pugh 评分为 5 分。HCC 被诊断为巴塞罗那临床肝癌 C 期。
我们开始用阿替利珠单抗联合贝伐珠单抗治疗。首次给药后 2 天出现肝功能障碍，但通过静脉补液改善，第二次给药后未再出现。HCC 缩小，但第四次给药后肾上腺转移增大，因此我们将治疗方案改为 LEN。LEN 使 HCC 和肾上腺转移灶坏死后，进行了转化手术。
成功转化治疗后，患者一般状况良好，截至目前已密切随访 4 个月，无进一步复发迹象。
即使阿替利珠单抗联合贝伐珠单抗无效，也可以进行 LEN 等多学科治疗和转化手术。鉴于 LEN 在阿替利珠单抗联合贝伐珠单抗之后的疗效，对于不可切除 HCC 患者，即使一线治疗无效，也有治愈的可能，这一点很重要。
