Fibrolamellar hepatocellular carcinoma treated with atezolizumab and bevacizumab: two case reports

Abstract

Background Fibrolamellar hepatocellular carcinoma is a unique tumor of the liver that differs from the classical hepatocellular carcinoma in diagnosis, behavior, and possibly treatment. There is usually absent underlying liver disease, and it usually occurs in young patients. The survival outcomes in localized fibrolamellar hepatocellular carcinoma are perhaps better than in classical hepatocellular carcinoma if treated early and radically. On the other hand, the prognosis remains poor for locally advanced and metastatic fibrolamellar hepatocellular carcinoma. Many reports suggested a limited benefit from systemic chemotherapy. Sorafenib also did not show major effects on fibrolamellar hepatocellular carcinoma. Given the rarity of fibrolamellar hepatocellular carcinoma, lack of large studies, and absence of standard treatment, the treatment decisions rely on case reports, previously reported cases series, and expert opinions. Recent studies have shown promising effects of immunotherapy with checkpoint inhibitors in the first- and second-line therapy of hepatocellular carcinoma. Atezolizumab with bevacizumab regimen has been approved recently as a first-line treatment for classical hepatocellular carcinoma. Currently, there are no reports yet on the use of atezolizumab with bevacizumab for fibrolamellar hepatocellular carcinoma. Case report In this article, we present two Arabic patients with advanced fibrolamellar hepatocellular carcinoma who received atezolizumab and bevacizumab combinations but did not show any clinical benefits. Conclusion While atezolizumab and bevacizumab combinations had shown benefits in classical hepatocellular carcinoma, the current data showed a lack of benefit and tumor response in fibrolamellar hepatocellular carcinoma.

Current Advances in the Treatment of Fibrolamellar Carcinoma of Liver

“…Unfortunately, the treatment did not show any clinical benefits. 56 Several case reports have shown the potential efficacy of immunotherapy in FLC, either with pembrolizumab, 57 nivolumab monotherapy, 58 or combining nivolumab and ipilimumab. 59 There was a retrospective cohort study of patients with FLC identified using the Johns Hopkins Liver Cancer Database, the UT Southwestern 1).…”

Molecular Targets for Novel Therapeutics in Pediatric Fusion-Positive Non-CNS Solid Tumors

“…Current treatments for FL-HCC remain in development. Chemotherapy for unresectable hepatocellular carcinoma (HCC) is a combination of atezolizumab and bevacizumab, but this therapy showed no clinical benefits in case studies in two patients with advanced FL-HCC ( Al Zahrani and Alfakeeh, 2021 ). Sorafenib is another multi-tyrosine kinase inhibitor in use against advanced HCC; however, sorafenib has limited efficacy against FL-HCC, with only delayed progression of disease as the best response ( Ang et al, 2013 ).…”