J Liver Cancer.  2025 Mar;25(1):134-137. 10.17998/jlc.2024.09.26.

Durable complete response after discontinuation of atezolizumab-bevacizumab therapy in patients with hepatocellular carcinoma with portal vein tumor thrombosis: the first report

• Kumar P
• Krishna P
• Maidur R
• Chandrashekhar N
• Raghavaiah S

• KMID: 2567071
• DOI: http://doi.org/10.17998/jlc.2024.09.26

Abstract

Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with a dismal prognosis. Atezolizumab plus bevacizumab (atezo-bev) is the recommended palliative treatment, and approximately 10% of the patients may experience a complete response (CR), according to the mRECIST criteria. The treatment duration is until disease progression or unacceptable side effects occur. Long-term continuation can cause potential toxicities and a substantial financial burden, making early treatment discontinuation a viable option. This report describes durable CR after discontinuing atezo-bev treatment in three patients with HCC and PVTT.

Keyword

Liver cirrhosis; Carcinoma, hepatocellular; Immunotherapy; Liver transplantation; Hepatitis C

Figure

• 

  Figure 1. Complete response of hepatocellular carcinoma after treatment with atezolizumab (Atezo) plus bevacizumab (Bev), i.e., disappearance of tumoral arterial enhancement in the arterial phase of triphasic CT abdomen according to the mRECIST criteria and loss of FDG activity in PET scans. (A) Case 1, (B) case 2, and (C) case 3. FDG-PET, 18F-fluorodeoxyglucose positron-emission mography; CT, computed tomography; mRECIST, modified response evaluation criteria in solid tumors.

• 

  Figure 2. Dynamic changes in alpha-fetoprotein levels during treatment and follow-up

Reference

References

1. Gavriilidis P, Pawlik TM, Azoulay D. Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus: state of art and future perspectives. Hepatobiliary Pancreat Dis Int. 2024; 23:221–227.

2. Gordan JD, Kennedy EB, Abou-Alfa GK, Beal E, Finn RS, Gade TP, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline update. J Clin Oncol. 2024; 42:1830–1850.

3. Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020; 382:1894–1905.

4. Johnson DB, Nebhan CA, Moslehi JJ, Balko JM. Immune-checkpoint inhibitors: long-term implications of toxicity. Nat Rev Clin Oncol. 2022; 19:254–267.

5. Yin J, Song Y, Tang J, Zhang B. What is the optimal duration of immune checkpoint inhibitors in malignant tumors? Front Immunol. 2022; 13:983581.

6. Chen AP, Sharon E, O'Sullivan-Coyne G, Moore N, Foster JC, Hu JS, et al. Atezolizumab for advanced alveolar soft part sarcoma. N Engl J Med. 2023; 389:911–921.

7. Hidaka Y, Tomita M, Desaki R, Hamanoue M, Takao S, Kirishima M, et al. Conversion surgery for hepatocellular carcinoma with portal vein tumor thrombus after successful atezolizumab plus bevacizumab therapy: a case report. World J Surg Oncol. 2022; 20:228.

8. Kumar P, Krishna P, Nidoni R, Adarsh CK, Arun MG, Shetty A, et al. Atezolizumab plus bevacizumab as a downstaging therapy for liver transplantation in hepatocellular carcinoma with portal vein thrombosis: the first report. Am J Transplant. 2024; 24:1087–1090.

9. Sharpe AH. Introduction to checkpoint inhibitors and cancer immunotherapy. Immunol Rev. 2017; 276:5–8.

10. Cercek A, Lumish M, Sinopoli J, Weiss J, Shia J, Lamendola-Essel M, et al. PD-1 Blockade in mismatch repair-deficient, locally advanced rectal cancer. N Engl J Med. 2022; 386:2363–2376.