Liver abscess in advanced hepatocellular carcinoma after atezolizumab plus bevacizumab treatment: A case report

Abstract

Rationale: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC.Patient concerns: A 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital.Diagnosis: Abdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess.Interventions: Percutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed.Outcomes: Despite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient's respiratory condition and renal function gradually worsened; The patient's general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37.Lessons: We report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC.

Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report

“…The relevant etiologies in HCC patients include malignancy-related biliary obstruction and contamination during procedures like radiofrequency ablation or TACE, which this patient did not undergo [ 7 ]. Regarding the treatment side effects, abscess formation after target therapy in HCC patients is extremely rare, with no known mechanism [ 8 ]. In this case, only the large tumor size and exceeded necrotic volume are worth noting as possible predisposing factors [ 9 ].…”

Complications of immunotherapy in advanced hepatocellular carcinoma

“…However, despite 37 days of intensive care unit treatment, he showed no improvement in sepsis and experienced worsening renal function. 30 An 80-year-old man was admitted to the hospital on the 22nd day following treatment with tremelimumab and durvalumab, presenting with dyspnea and myalgia. He was diagnosed with torsade de pointes.…”

Systemic therapies in hepatocellular carcinoma: A revolution?

“…On the other hand, there are several case reports showing the unpredictable and infrequent severe side effects with different outcomes, such as atezolizumab‐induced encephalitis, 34 , 35 hypopituitarism, 36 polymyalgia rheumatica, 37 adrenocorticotropic hormone deficiency, hypothyroidism and myopathy 38 myocarditis, 39 psoriasiform eruption, 40 autoimmune diabetes mellitus, Takotsubo cardiomyopathy, 41 small bowel perforation, 42 Evans' syndrome, 43 duodenal variceal rupture, 44 liver abscess, 45 thrombotic microangiopathy and mesangial proliferative glomerulonephritis during atezolizumab and bevacizumab treatment. 46 Case reports are scanty in the case of tremelimumab and durvalumab and only a shellfish allergy after treatment has been described but there is less available data due to the late incorporation.…”