Atezolizumab/bevacizumab

Abstract

Hyperprogressive disease in hepatocellular cancer: case report A 36-year-old man developed hyperprogressive disease in hepatocellular cancer (HCC) during treatment with atezolizumab and bevacizumab for HCC. The man was hospitalised with abdominal pain, nausea and vomiting. He experienced weight loss. On 21 August 2020, CT scan of the abdomen and pelvis with IV contrast revealed a large heterogeneous mass in the left lobe of the liver measuring 11 × 10 × 10cm. He underwent a CT-guided biopsy of the liver mass which was consistent with HCC. A diagnostic laparoscopy demonstrated left lobe mass involving segments 2 and 3, nodular lesion on the peritoneum overlying segment 2 of the liver, nodular area on the anterior surface of segment 4 and wedge resection of the posterior surface of segment 4 (3.0 × 2.2 × 1.7cm). Final pathology of the wedge resection of segment 4 revealed 3 separate nodules consistent with HCC, which was deemed to be unresectable. He was discharged with recommendation of outpatient follow-up. He was initiated on atezolizumab and bevacizumab on 5 October 2020 [routes and dosages not stated]. However, three weeks later, he presented again to emergency department with abdominal pain. He was re-admitted. On 26 October 2020, a CT chest/abdomen/pelvis with contrast demonstrated multiple bilateral lung nodules (all size less than 1cm), large (21 × 10.9 × 16.5cm) heterogeneously enhancing mass in the left lobe of the liver, and interval development of additional small multiple hypodense lesions in the right lobe of the liver. These findings were consistent with multicentric HCC. He was diagnosed with hyperprogressive disease, suspected to be secondary to atezolizumab and bevacizumab therapy. His performance status declined to ECOG 3-4 [time to reaction onset not clearly stated]. Atezolizumab and bevacizumab therapy was discontinued following administration of only one cycle. The man was initiated on palliative care [outcome not stated].