A Case of Hepatocellular Carcinoma Successfully Resumed Atezolizumab and Bevacizumab After Associated Grade 3 Diarrhea and Grade 2 Colitis: Case Report and Literature Review

A Case of Hepatocellular Carcinoma Successfully Resumed Atezolizumab and Bevacizumab After Associated Grade 3 Diarrhea and Grade 2 Colitis: Case Report and Literature Review

Systemic chemotherapy has shown a significant survival benefit in patients with hepatocellular carcinoma (HCC). However, it is associated with various immune-related adverse events (irAEs). We report a case with grade 3 diarrhea and grade 2 colitis following systemic chemotherapy, successfully treat...

Full description

Saved in:
Bibliographic Details
Published in:OncoTargets and therapy Vol. 15; pp. 1281 - 1288
Main Authors: Fuji, Takahiro, Otoyama, Jun Arai Yumi, Nio, Yuta, Sugiura, Ikuya, Nakajima, Yoko, Kajiwara, Atsushi, Ichikawa, Yuki, Uozumi, Shojiro, Shimozuma, Yuu, Uchikoshi, Manabu, Sakaki, Masashi, Nozawa, Hisako, Momo, Kenji, Sasaki, Tadanori, Yoshida, Hitoshi
Format: Journal Article
Language:English
Published: Macclesfield Dove Medical Press Limited 31-10-2022
Taylor & Francis Ltd
Dove
Subjects:
Antagonists
Antigens
Bevacizumab
Bilirubin
Cancer
Cancer therapies
Care and treatment
Case Report
Case reports
Chemotherapy
Colitis
Colon
Colonoscopy
Computed tomography
Contrast media
Corticosteroids
Cytomegalovirus
Development and progression
Diarrhea
Hepatitis
Hepatocellular carcinoma
Hepatoma
Immunotherapy
Inflammatory bowel disease
Ipilimumab
Literature reviews
Liver cancer
Liver cirrhosis
Liver diseases
Medical prognosis
Metastases
Metastasis
Monoclonal antibodies
Nodules
Nutrient deficiency
Oral administration
Patients
Prednisolone
Solid tumors
Steroids
Survival
Targeted cancer therapy
Vitamin K
Japan
Slovenia
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Systemic chemotherapy has shown a significant survival benefit in patients with hepatocellular carcinoma (HCC). However, it is associated with various immune-related adverse events (irAEs). We report a case with grade 3 diarrhea and grade 2 colitis following systemic chemotherapy, successfully treated with prednisolone. An 89-year-old man was incidentally detected with a 140-mm hypervascular intrahepatic nodule on contrast-enhanced computed tomography (CECT). Washout of the contrast medium was also detected, and protein induced by vitamin K deficiency or antagonists-II (PIVKA-II) was elevated. Since the Albumin-Bilirubin (ALBI) grade was 2a without any distant metastasis, transarterial chemoembolization (TACE) was performed to treat the HCC, but several intrahepatic nodules were seen in both lobes. Therefore, the patient was treated with lenvatinib for 1 year and 4 months. A complete response according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria was achieved in 2 months; however, multiple hypervascular nodules were detected again. Since the ALBI grade was 1, a second round of chemotherapy with atezolizumab and bevacizumab was initiated. Although a complete response was achieved, the therapy was discontinued due to grade 3 diarrhea and grade 2 colitis after the sixth course. Based on the stool analysis and culture, CECT, and colonoscopy, the diagnosis was atezolizumab-associated colitis. Diarrhea was controlled following the oral administration of 0.5 mg/ kg/day of prednisolone, and atezolizumab-bevacizumab therapy was successfully reinitiated without recurrence of colitis. The management of irAEs is important for a significant survival benefit. Systemic chemotherapy with atezolizumab and bevacizumab can be resumed despite a grade 3 irAE due to atezolizumab. Keywords: hepatocellular carcinoma, immune checkpoint inhibitors, immune-related adverse events, ICI-mediated colitis, IL-17, PIVKA-II
ISSN:1178-6930
1178-6930
DOI:10.2147/OTT.S383769