Park KH, Yoo JJ, Kim SG, Kim YS. Fatal intratumoral hemorrhage in a patient with hepatocellular carcinoma following successful treatment with atezolizumab/bevacizumab: A case report. World J Clin Cases 2024; 12(22): 5177-5183 [PMID: 39109046 DOI: 10.12998/wjcc.v12.i22.5177]
Corresponding Author of This Article
Jeong-Ju Yoo, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, 170 Jomaruro Wonmigu, Bucheonsi Gyeonggido, Bucheon 14584, South Korea.puby17@naver.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2024; 12(22): 5177-5183 Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.5177
Fatal intratumoral hemorrhage in a patient with hepatocellular carcinoma following successful treatment with atezolizumab/bevacizumab: A case report
Kyeong-Hoon Park, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
Kyeong-Hoon Park, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim, Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
Author contributions: Yoo JJ contributed to conceptualization and supervision; Park KH contributed to formal analysis; Kim SG and Kim YS contributed to investigation; Park KH contributed to manuscript writing; Yoo JJ contributed to manuscript review and editing; All authors have read and approved the final manuscript.
Supported bySoonchunhyang University Research Fund, No. 20240007.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and all accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeong-Ju Yoo, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, 170 Jomaruro Wonmigu, Bucheonsi Gyeonggido, Bucheon 14584, South Korea.puby17@naver.com
Received: March 14, 2024 Revised: May 28, 2024 Accepted: June 13, 2024 Published online: August 6, 2024 Processing time: 110 Days and 7.2 Hours
Abstract
BACKGROUND
Atezolizumab/bevacizumab is emerging as the new standard for advanced hepatocellular carcinoma (HCC), with ongoing real-world implementation to study its effectiveness. As the use of atezolizumab/bevacizumab increases, various side effects have been reported in clinical practice, most notably increased bleeding caused by bevacizumab.
CASE SUMMARY
In this case report, we present a rare and fatal case of intratumoral hemorrhage in a patient with advanced HCC following successful treatment with atezolizumab/bevacizumab. A 63-year-old male diagnosed with HCC initially underwent four cycles of intra-arterial chemotherapy. However, follow-up abdominal computed tomography (CT) revealed disease progression. Subsequently, the treatment plan was modified to atezolizumab/bevacizumab. After the fifth cycle of atezolizumab/bevacizumab, CT showed partial regression of HCC. One week later, he visited the emergency room due to severe abrupt abdominal pain. Abdominal CT revealed focal rupture of HCC in the medial segment inferior portion with active bleeding and a large amount of hemoperitoneum. Angiography was performed on the same day, and embolization of A4 and A8 branches using lipiodol and gelfoam was implemented. Despite successful hemostasis, the patient subsequently developed liver failure and died.
CONCLUSION
Atezolizumab/bevacizumab for advanced HCC suggests that intratumoral hemorrhage may be crucial despite good tumor response after immunotherapy, emphasizing the continuous monitoring of this side effect.
Core Tip: Our study delves into the emerging therapy of atezolizumab/bevacizumab for unresectable hepatocellular carcinoma (HCC), contrasting its efficacy with traditional treatments like sorafenib. We highlight the real-world challenges of bleeding complications, particularly intratumoral bleeding, associated with bevacizumab. Presenting a rare case, we emphasize the need for proactive measures, such as baseline examinations, to mitigate bleeding risks before initiating atezolizumab/bevacizumab. Our findings underscore the critical importance of vigilant monitoring and prompt intervention to address potentially fatal complications during atezolizumab/bevacizumab therapy, contributing to the evolving understanding of HCC treatment strategies.
