贝伐珠单抗联合替西木单抗治疗肝细胞癌患者发生静脉曲张出血后可考虑降低剂量或停药:病例报告。

Reduced-Dose or Discontinuation of Bevacizumab Might Be Considered after Variceal Bleeding in Patients with Hepatocellular Carcinoma Receiving Atezolizumab/Bevacizumab: Case Reports.

机构信息

Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea.

出版信息

Medicina (Kaunas). 2024 Jan 15;60(1):157. doi: 10.3390/medicina60010157.

Abstract

: Variceal bleeding (VB) is the most concerning condition that is difficult to treat after atezolizumab/bevacizumab in patients with advanced hepatocellular carcinoma (HCC). : We would like to introduce the cases of two patients who underwent bevacizumab reduction or discontinuation when VB occurred after atezolizumab/bevacizumab. : VB occurred in two patients who showed good tumor response after atezolizumab/bevacizumab treatment, and all VBs were successfully treated with endoscopic variceal ligations. In the first patient, VB did not occur as the tumor response decreased after a 50% reduction in bevacizumab. In the second patient, VB occurred again after a 50% bevacizumab reduction, so bevacizumab was discontinued and treatment with atezolizumab alone has been successfully maintained. : Accordingly, we would like to suggest that considering bevacizumab dose reduction instead of changing to tyrosine kinase inhibitor may be a good clinical choice in atezolizumab/bevacizumab patients who develop VB.

摘要

: 贝伐珠单抗联合阿替利珠单抗治疗晚期肝细胞癌(HCC)后,患者易发生难以治疗的静脉曲张出血(VB)。: 我们将介绍两例 VB 发生后贝伐珠单抗减量或停药的患者。: 两例患者在接受阿替利珠单抗/贝伐珠单抗治疗后肿瘤反应良好时发生 VB,所有 VB 均通过内镜静脉曲张结扎术成功治疗。在第一个患者中,当贝伐珠单抗减少 50%时肿瘤反应下降,VB 未发生。在第二个患者中,贝伐珠单抗减少 50%后 VB 再次发生,因此停用贝伐珠单抗,单独使用阿替利珠单抗治疗已成功维持。: 因此,我们建议对于发生 VB 的阿替利珠单抗/贝伐珠单抗患者,考虑贝伐珠单抗剂量减少而非换用酪氨酸激酶抑制剂可能是一个较好的临床选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cc19/10820589/6af245cd6c1b/medicina-60-00157-g001.jpg

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