Successful multidisciplinary treatment with complete response to atezolizumab plus bevacizumab in a 90-year-old patient with hepatocellular carcinoma recurrence

Kiyotaka Hosoda; Takeo Toshima; Junichi Takahashi; Yusuke Yonemura; Yuichi Hisamatsu; Kosuke Hirose; Takaaki Masuda; Yushi Motomura; Tadashi Abe; Yuki Ando; Katsushi Dairaku; Yusuke Nakano; Masahiro Hashimoto; Yoshiki Hiraki; Yuji Soejima; Tomoharu Yoshizumi; Koshi Mimori

doi:10.1007/s13691-023-00618-6

Successful multidisciplinary treatment with complete response to atezolizumab plus bevacizumab in a 90-year-old patient with hepatocellular carcinoma recurrence

Int Cancer Conf J. 2023 Jun 23;12(4):274-278. doi: 10.1007/s13691-023-00618-6. eCollection 2023 Oct.

Authors

Kiyotaka Hosoda^{1

2}, Takeo Toshima^{1

3}, Junichi Takahashi¹, Yusuke Yonemura¹, Yuichi Hisamatsu¹, Kosuke Hirose¹, Takaaki Masuda¹, Yushi Motomura⁴, Tadashi Abe¹, Yuki Ando¹, Katsushi Dairaku¹, Yusuke Nakano¹, Masahiro Hashimoto¹, Yoshiki Hiraki⁴, Yuji Soejima², Tomoharu Yoshizumi^{1

3}, Koshi Mimori¹

Affiliations

¹ Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita 874-0838 Japan.
² Division of Gastroenterological, Department of Surgery, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
³ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁴ Department of Radiology, Kyushu University Beppu Hospital, Beppu, Japan.

PMID: 37577350
PMCID: PMC10421829 (available on 2024-06-23)
DOI: 10.1007/s13691-023-00618-6

Abstract

Atezolizumab plus bevacizumab is the first-line regimen in Japan for hepatocellular carcinoma following the results of the IMbrave 150 trial. However, the safety and efficiency of atezolizumab plus bevacizumab in older patients, especially in the oldest-old patients aged over 80 years, have not been thoroughly studied and is still controversial. Eighteen months ago, a 90-year-old woman underwent a laparoscopic hepatectomy (S6) for her primary hepatocellular carcinoma (S6, 2 cm). Nine months after the first surgery, she received transcatheter arterial chemoembolization treatment for solitary hepatocellular carcinoma recurrence (S8, 2 cm). The subsequent recurrence (S3, 1 cm; S5, 2 cm; S8, 1 cm) was uncovered by radiological assessment 1 year after transcatheter arterial chemoembolization treatment. We then initiated chemotherapy treatment with lenvatinib at 8 mg daily. Despite reducing the lenvatinib dosage, the adverse event of severe fatigue and asitia did not resolve; therefore, the regimen of atezolizumab + bevacizumab combination therapy was changed to be started. After the first 2 months, tumor regression was observed on computed tomography; the patient tolerated the atezolizumab + bevacizumab combination regimen over 8 months for 10 cycles without any adverse effects. She finally showed a complete response; no recurrence developed 1 year after the complete response. Therefore, older adult patients may benefit highly from atezolizumab plus bevacizumab with appropriate patient selection.

Keywords: Atezolizumab; Bevacizumab; Complete response; Hepatocellular carcinoma; Immune checkpoint inhibitor; Older adult patient.

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