Partial Splenic Embolization for Portal Hypertension Exacerbation During Atezolizumab/Bevacizumab Combination Therapy in Unresectable Hepatocellular Carcinoma.

BACKGROUND/AIM: The combination of atezolizumab and bevacizumab is the standard treatment for hepatocellular carcinoma (HCC). However, cases of portal hypertension (PHT) have been reported with atezolizumab/bevacizumab combination therapy. Splenomegaly caused by PHT may disrupt the immune environment and increase the risk of therapeutic failure with this combination therapy. Partial splenic embolization (PSE) is a treatment option for splenomegaly; however, the usefulness of PSE for PHT during atezolizumab/bevacizumab combination therapy is unclear. This study investigated the effect of PSE on the immune environment in a patient with splenomegaly caused by exacerbation of PHT during atezolizumab/bevacizumab combination therapy for HCC.

PATIENTS AND METHODS

Of the 56 patients with unresectable HCC treated with atezolizumab/bevacizumab, four with splenomegaly and progressive disease (PD) underwent PSE.

RESULTS

PHT during atezolizumab/bevacizumab combination therapy led to a mean enlargement of the splenic size of 142.7%, an increase in the neutrophil-lymphocyte ratio (NLR), a decrease in lymphocyte counts, and a decrease in platelet counts. PSE increased platelet counts and lymphocyte counts, and decreased the NLR compared with pre-PSE levels. Atezolizumab/bevacizumab combination therapy, which caused PD due to PHT, resulted in a non-PD state with continued treatment after PSE.

CONCLUSION

In patients with PHT receiving atezolizumab/bevacizumab combination therapy, PSE promotes recovery from leukopenia and thrombocytopenia. Furthermore, PSE treatment may also induce host immune activation and boost immunity.