贝伐珠单抗联合阿替利珠单抗治疗复发性肝癌伴远隔效应 1 例

Abscopal effect in a patient with advanced hepatocellular carcinoma upon resuming bevacizumab in combination with atezolizumab after radiotherapy.

机构信息

Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan.

Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan.

出版信息

Clin J Gastroenterol. 2024 Dec;17(6):1053-1057. doi: 10.1007/s12328-024-02030-w. Epub 2024 Aug 14.

Abstract

Combining bevacizumab with atezolizumab enhances the antitumor effects of the treatment by activating an immune response. This combination is approved for the treatment of unresectable hepatocellular carcinoma (HCC). An abscopal effect is associated with an immune response triggered by radiation-induced immunogenic cell death, based on experimental models. Thus, combining radiotherapy and immunotherapy is expected to induce an abscopal effect. However, the clinical significance of immunotherapy in the abscopal effect remains unknown due to the rarity of clinical cases. Herein, we report a case of advanced HCC with lung and adrenal metastases. The antitumor efficacy of atezolizumab and bevacizumab (atezo/bev) was enhanced following stereotactic body radiotherapy (SBRT), although atezo/bev did not yield a sufficient therapeutic response pre-SBRT. Furthermore, an abscopal effect following SBRT was not observed during atezolizumab alone but was evoked after resuming bevacizumab in combination with atezolizumab, culminating in the patient achieving a complete response status. These findings suggest that immune activation following radiotherapy may be related to the induction of an abscopal effect in clinical practice as well as in experimental settings, and combining immunotherapy with bevacizumab post-radiotherapy could evoke an abscopal effect in a case of HCC, even though immune checkpoint inhibitor use alone may be insufficient.

摘要

贝伐珠单抗联合阿替利珠单抗通过激活免疫反应增强了治疗的抗肿瘤作用。这种联合治疗方案已被批准用于治疗不可切除的肝细胞癌(HCC)。基于实验模型,放射诱导的免疫原性细胞死亡引发的免疫反应与远隔效应相关。因此,联合放疗和免疫治疗有望诱导远隔效应。然而,由于临床病例罕见,免疫疗法在远隔效应中的临床意义尚不清楚。在此,我们报告了一例晚期 HCC 伴肺和肾上腺转移的病例。在立体定向体部放射治疗(SBRT)后,阿替利珠单抗和贝伐珠单抗(atezo/bev)的抗肿瘤疗效增强,尽管在 SBRT 前 atezo/bev 未产生足够的治疗反应。此外,阿替利珠单抗单药治疗后未观察到远隔效应,但在重新开始贝伐珠单抗联合阿替利珠单抗治疗后出现了远隔效应,最终患者达到完全缓解状态。这些发现表明,放疗后的免疫激活可能与临床实践以及实验环境中诱导远隔效应有关,并且在放射治疗后联合免疫治疗和贝伐珠单抗可能会在 HCC 病例中引发远隔效应,尽管单独使用免疫检查点抑制剂可能不够。

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