Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2024 Aug;123(8):916-919. doi: 10.1016/j.jfma.2024.03.019. Epub 2024 Apr 2.
Atezolizumab/bevacizumab combination therapy became the first-line therapy for advanced hepatocellular carcinoma (HCC). Gastroesophageal varices should be monitored and managed before treatment. The progression of portal hypertension during bevacizumab-containing therapy is unclear.
A case of new development of esophageal varices, ascites, and hepatic hydrothorax during atezolizumab/bevacizumab therapy at National Taiwan University Hospital was reported, and relevant literature was reviewed.
We presented an 83-year-old male with resolved hepatitis B without cirrhosis. He had BCLC stage C HCC and received tri-weekly atezolizumab/bevacizumab therapy for 34 cycles with sustained partial response. Progressive ascites, esophageal varices, and hepatic hydrothorax developed, though his portal vein was patent and the tumor was under control. Five similar cases of HCC (BCLC B/C: n = 3/2) had been reported previously. Among them, three had cirrhosis with pre-existing small esophageal varices before treatment. After the administration of 1-15 cycles of atezolizumab/bevacizumab therapy, one patient had a progression of varices, and the other four developed variceal bleeding. The association between atezolizumab/bevacizumab and portal hypertension was possible, which might relate to the VEGF pathway and immune-related adverse events with progressive hepatic fibrosis.
Atezolizumab/bevacizumab treatment might exacerbate portal hypertension. Careful monitoring and management should be considered during treatment.
阿替利珠单抗/贝伐珠单抗联合治疗已成为晚期肝细胞癌（HCC）的一线治疗方法。治疗前应监测和管理胃食管静脉曲张。贝伐珠单抗治疗期间门静脉高压的进展尚不清楚。
报告了一例在国立台湾大学医院接受阿替利珠单抗/贝伐珠单抗治疗期间新出现食管静脉曲张、腹水和肝性胸水的病例，并复习了相关文献。
我们报告了一例 83 岁男性，乙型肝炎已治愈且无肝硬化。他患有 BCLC 分期 C HCC，并接受了每周三次的阿替利珠单抗/贝伐珠单抗治疗，共 34 个周期，持续部分缓解。尽管门静脉通畅且肿瘤得到控制，但进展性腹水、食管静脉曲张和肝性胸水仍在发展。先前已报道了 5 例类似的 HCC（BCLC B/C：n=3/2）病例。其中，3 例有肝硬化，治疗前存在小的食管静脉曲张。在接受阿替利珠单抗/贝伐珠单抗治疗 1-15 个周期后，1 例患者的静脉曲张进展，另外 4 例患者出现静脉曲张出血。阿替利珠单抗/贝伐珠单抗与门静脉高压之间可能存在关联，这可能与 VEGF 通路和免疫相关的不良反应以及进行性肝纤维化有关。
阿替利珠单抗/贝伐珠单抗治疗可能会加重门静脉高压。在治疗期间应考虑进行仔细监测和管理。
