Two cases of unresectable hepatocellular carcinoma treated via atezolizumab and bevacizumab combination therapy

Surgical Case Reports, Journal Year: 2023, Volume and Issue: 9(1)

Published: June 2, 2023

Abstract Background Treatment of hepatocellular carcinoma (HCC) varies widely depending on the patient's condition. In recent years, combination therapy with immune checkpoint inhibitors has emerged as treatment choice due to its superior antitumor effects for unresectable HCC (uHCC). Conversion surgery (CS) after systemic chemotherapy is expected be an effective strategy uHCC. Here, we report two cases uHCC bilateral porta hepatis invasion, in which atezolizumab plus bevacizumab regressed tumor invasion hepatis, followed by CS R0 resection. Case presentation The first patient—a 71-year-old man S4 HCC—developed and compressed right portal vein bile duct. resection left trihepatectomy was impossible because insufficient liver function, using initiated. After ten courses treatment, shrunk regression contact, segmentectomy performed a sufficient surgical margin. Histopathological findings showed that primary mostly necrotic no residual viable cells. second patient 72-year-old extending hepatis. patient’s condition almost similar case required tri-segmentectomy resection; however, function made impossible. An regimen administered, seven compression regressed, following lobectomy adequate margins. pathological diagnosis moderately differentiated HCC, most necrotic, confirmed. Conclusions Atezolizumab potential facilitate radical patients

Language: Английский

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Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis

Liver Cancer, Journal Year: 2023, Volume and Issue: 13(3), P. 235 - 245

Published: Oct. 14, 2023

<b><i>Background:</i></b> Safety and outcome of atezolizumab/bevacizumab in Child-Pugh B patients with hepatocellular carcinoma (HCC) have not been completely characterized. <b><i>Objectives:</i></b> In this study, we aimed at addressing safety efficacy by reviewing the available data analyzing them meta-analysis. <b><i>Methods:</i></b> We compared atezolizumab/becavizumab treatment unresectable HCC various degrees liver dysfunction. A total 8 retrospective, non-randomized, cohort studies were included meta-analysis, for a 1,071 225 patients. The albumin-bilirubin (ALBI) grade was also used to assess function, when available. <b><i>Results:</i></b> Grade ≥3 adverse events observed 11.8% class 26.8% (<i>p</i> = 0.0001), an odds ratio (OR) 0.43 (confidence interval [CI] 0.21–0.90; <i>p</i> 0.02). Progression-free survival (PFS) both 6 months (4.90 ± 2.08 vs. 4.75 months; 0.0004) 12 (8.83 2.32 7.26 2.33 0.002) lower trend toward higher objective response rate (ORR) (219/856, 25.6%) as (25/138, 18.1%; 0.070), while probability obtaining ORR significantly greater (OR 1.79, CI 1.12–2.86; Median overall (OS) 16.8 2.0 6.8 3.2 patients, respectively (mean difference 9.06 months, 7.01–11.1, &lt; 0.0001). Lastly, OS longer ALBI grades 1–2 than those 3 (8.3 11.4 3.3 5.0 0.0008). <b><i>Conclusions:</i></b> Oncological is moderate shorter PFS associated likelihood experiencing treatment-related these suggest great caution individualization treatment, possibly support grade.

Language: Английский

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Time trend of outcomes according to systemic therapy for patients with unresectable hepatocellular carcinoma: A single‐institution study

Hepatology Research, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 26, 2024

We have been able to use molecular targeted agents for unresectable hepatocellular carcinoma since 2009, and immune checkpoint inhibitors approved in recent years. assessed the efficacy of systemic therapy Hiroshima University Hospital by each era.

Language: Английский

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Real-World Use of Immunotherapy for Hepatocellular Carcinoma

Pragmatic and Observational Research, Journal Year: 2023, Volume and Issue: Volume 14, P. 63 - 74

Published: Aug. 1, 2023

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide and accounts for 90% all primary liver cancers. Chronic inflammation hallmark across prevalent etiologies among which HBV leading (33%), followed by alcohol (30%), HCV (21%), other factors like non-alcoholic steatohepatitis linked to insulin resistance/metabolic syndrome, obesity associated (16%). Deregulation tightly controlled immunological network leads disease, including chronic infection, autoimmunity, tumor development. While drives oncogenesis in liver, HCC also recruits ICOS+ FOXP3+ Tregs MDSCs upregulates immune checkpoints induce a state immunosuppression microenvironment. As such, research focused on targeting modulating system treat HCC. The Checkmate 040 Keynote 224 studies established role immunotherapy treatment patients with In Phase I II trials, nivolumab pembrolizumab demonstrated durable response rates 15-20% were subsequently approved as second-line agents after sorafenib. Due success IMbrave 150 HIMALAYA examined combination atezolizumab/bevacizumab tremelimumab/durvalumab, respectively, FDA these regimens first-time options advanced encouraging results management has led researchers evaluate if locoregional therapies may result synergistic effect. Real-world represent an invaluable tool assess verify applicability clinical trials bedside setting more varied patient population. We herein review current real-life use ICIs highlight some ongoing that are expected change recommended first-line near future.

Language: Английский

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Immune checkpoint inhibition (ICI) in current systemic therapies for hepatocellular carcinoma (HCC)

ESMO Gastrointestinal Oncology, Journal Year: 2023, Volume and Issue: 1, P. 27 - 39

Published: Oct. 1, 2023

Immune checkpoint inhibition (ICI) has revolutionized cancer therapy, including treatment of hepatocellular carcinoma (HCC) which comprises 80%-90% all liver cancers, the third most common cause cancer-related death worldwide. The main targeted pathways are cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) and programmed cell protein 1 (PD-1)/programmed death-ligand (PD-L1) checkpoints. Blockade CTLA-4 with monoclonal antibodies leads to an activation increase in effector T cells that can interact tumor cells. Additionally, inhibitory regulatory reduced, leading immunosupportive microenvironment. PD-1/PD-L1 reduces immunosuppression directly within tissue reactivates immune response Recently, HIMALAYA trial shown dual ICI CTLA-4-blocking antibody tremelimumab PD-L1-directed durvalumab (STRIDE regimen) is superior sorafenib regarding efficacy safety advanced HCC unprecedented long-term survival data for these patients. combination (atezolizumab) anti-vascular endothelial growth factor (bevacizumab) significantly improved outcomes compared been clinical use since 2020. Looking at outcome measures ICI, radiologically assessed endpoints such as progression-free objective rate only modestly correlate overall survival. modified RECIST criteria seem better identify responders conventional imaging evaluation criteria. So far, predictive biomarkers a robust understanding impact underlying diseases largely lacking. An accurate stratification patients based on etiology potential further improve HCC.

Language: Английский

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