Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma
Recently, combination therapy with atezolizumab, a humanized monoclonal antiprogrammed death ligand-1 antibody, and bevacizumab, has become available for treatment of unresectable hepatocellular carcinoma (HCC). We herein report a 73-year-old man with advanced stage HCC who developed fatigue during...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043323003849 |
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| author | Yasuhito Mitsuyama, MD Ken Kageyama, MD, PhD Hiroji Shinkawa, MD, PhD Akira Yamamoto, MD, PhD Atsushi Jogo, MD, PhD Etsuji Sohgawa, MD Shogo Tanaka, MD, PhD Shigekazu Takemura, MD, PhD Shoji Kubo, MD, PhD Takeaki Ishizawa, MD, PhD Yukio Miki, MD, PhD |
| author_facet | Yasuhito Mitsuyama, MD Ken Kageyama, MD, PhD Hiroji Shinkawa, MD, PhD Akira Yamamoto, MD, PhD Atsushi Jogo, MD, PhD Etsuji Sohgawa, MD Shogo Tanaka, MD, PhD Shigekazu Takemura, MD, PhD Shoji Kubo, MD, PhD Takeaki Ishizawa, MD, PhD Yukio Miki, MD, PhD |
| author_sort | Yasuhito Mitsuyama, MD |
| collection | DOAJ |
| description | Recently, combination therapy with atezolizumab, a humanized monoclonal antiprogrammed death ligand-1 antibody, and bevacizumab, has become available for treatment of unresectable hepatocellular carcinoma (HCC). We herein report a 73-year-old man with advanced stage HCC who developed fatigue during treatment with atezolizumab–bevacizumab combination therapy. Computed tomography identified intratumoral hemorrhage within the HCC metastasis to the right fifth rib metastasis of HCC, which was confirmed on emergency angiography of the right 4th and 5th intercostal arteries and some branches of the subclavian artery confirmed intratumoral hemorrhage, following which transcatheter arterial embolization (TAE) was performed to achieve hemostasis. He continued to receive atezolizumab-bevacizumab combination therapy after TAE, and no rebleeding was seen. Although uncommon, rupture and intratumoral hemorrhage in the HCC metastasis to the ribs can cause life-threatening hemothorax. However, to our knowledge, no previous cases of intratumoral hemorrhage in HCC during atezolizumab–bevacizumab combination therapy have been reported. This is the first report of intratumoral hemorrhage with the combination therapy of atezolizumab and bevacizumab, which was successfully controlled by TAE. Patients receiving this combination therapy should be observed for intratumoral hemorrhage, which can be managed by TAE if it does occur. |
| first_indexed | 2024-03-12T22:22:22Z |
| format | Article |
| id | doaj.art-0aa665962fa64e2ba7325d8c74a83d3a |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-03-12T22:22:22Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-0aa665962fa64e2ba7325d8c74a83d3a2023-07-23T04:54:07ZengElsevierRadiology Case Reports1930-04332023-09-0118930373040Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinomaYasuhito Mitsuyama, MD0Ken Kageyama, MD, PhD1Hiroji Shinkawa, MD, PhD2Akira Yamamoto, MD, PhD3Atsushi Jogo, MD, PhD4Etsuji Sohgawa, MD5Shogo Tanaka, MD, PhD6Shigekazu Takemura, MD, PhD7Shoji Kubo, MD, PhD8Takeaki Ishizawa, MD, PhD9Yukio Miki, MD, PhD10Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, JapanDepartment of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, Japan; Corresponding author.Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abenoku, Osaka, JapanDepartment of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, JapanDepartment of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, JapanDepartment of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, JapanDepartment of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abenoku, Osaka, JapanDepartment of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abenoku, Osaka, JapanDepartment of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abenoku, Osaka, JapanDepartment of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abenoku, Osaka, JapanDepartment of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, JapanRecently, combination therapy with atezolizumab, a humanized monoclonal antiprogrammed death ligand-1 antibody, and bevacizumab, has become available for treatment of unresectable hepatocellular carcinoma (HCC). We herein report a 73-year-old man with advanced stage HCC who developed fatigue during treatment with atezolizumab–bevacizumab combination therapy. Computed tomography identified intratumoral hemorrhage within the HCC metastasis to the right fifth rib metastasis of HCC, which was confirmed on emergency angiography of the right 4th and 5th intercostal arteries and some branches of the subclavian artery confirmed intratumoral hemorrhage, following which transcatheter arterial embolization (TAE) was performed to achieve hemostasis. He continued to receive atezolizumab-bevacizumab combination therapy after TAE, and no rebleeding was seen. Although uncommon, rupture and intratumoral hemorrhage in the HCC metastasis to the ribs can cause life-threatening hemothorax. However, to our knowledge, no previous cases of intratumoral hemorrhage in HCC during atezolizumab–bevacizumab combination therapy have been reported. This is the first report of intratumoral hemorrhage with the combination therapy of atezolizumab and bevacizumab, which was successfully controlled by TAE. Patients receiving this combination therapy should be observed for intratumoral hemorrhage, which can be managed by TAE if it does occur.http://www.sciencedirect.com/science/article/pii/S1930043323003849Hepatocellular carcinomaTranscatheter arterial embolizationAtezolizumab and bevacizumab |
| spellingShingle | Yasuhito Mitsuyama, MD Ken Kageyama, MD, PhD Hiroji Shinkawa, MD, PhD Akira Yamamoto, MD, PhD Atsushi Jogo, MD, PhD Etsuji Sohgawa, MD Shogo Tanaka, MD, PhD Shigekazu Takemura, MD, PhD Shoji Kubo, MD, PhD Takeaki Ishizawa, MD, PhD Yukio Miki, MD, PhD Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma Radiology Case Reports Hepatocellular carcinoma Transcatheter arterial embolization Atezolizumab and bevacizumab |
| title | Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma |
| title_full | Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma |
| title_fullStr | Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma |
| title_full_unstemmed | Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma |
| title_short | Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma |
| title_sort | atezolizumab plus bevacizumab induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma |
| topic | Hepatocellular carcinoma Transcatheter arterial embolization Atezolizumab and bevacizumab |
| url | http://www.sciencedirect.com/science/article/pii/S1930043323003849 |
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