Targeted Immunotherapy for Hepatocellular Carcinoma: A Clinical Case

Abstract

Relevance: Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. HCC is one of the most important problems of the oncology service of Kazakhstan, as it has a progressive course, late detection, low survival, and unfavorable prognosis.
 The study aimed to evaluate the use of targeted immunotherapy in treating hepatocellular carcinoma in a clinical example.
 Methods: The paper presents a clinical case of targeted immunotherapy in combination with Atezolizumab 1200 mg + Bevacizumab 800 mg, once every 3 weeks, in treating HCC in the Regional Oncology Center in Kyzylorda.
 Results: The first symptoms of liver damage appeared in 2018, at which time HCC was discovered. Viral hepatitis B was diagnosed in 2016. MRI OBP from 15.08.20: a picture of the right lobe of the liver in S5 – 9×7×6 cm, in S3 – 3.7 cm, in S7 – 3.0 cm, in S8 – 2.5 cm. During the follow-up examination (July 2021), the enzyme immunoassay revealed a high angiotensin-converting enzyme (ACE) level of 450.56 IU/ml; the abdominal CT scan showed no deterioration. Later, despite the therapy, ACE increased rapidly: 2,595.3 IU/ml (August 2021) and 2,142.25 IU/ml (September 2021), and the therapy was changed to Regorafenib. ACE continued to rise to 4,405 IU/ml (November 2021) and 18,005 IU/ml (December 2021). A control abdominal CT scan showed a moderate reduction in the size of the tumor.
 Taking into account a steady ACE increase, in February 2022, the patient was recommended therapy with Atezolizumab and Bevacizumab. In January 2023, the patient has already received 13 courses, and ACE continued to decrease: 1,932 IU/ml (January 2023), 53.38 IU/ml (February 2023), 16.07 IU/ml (March 2023), and the abdominal CT scan showed positive dynamics.
 Conclusion: Targeted immunotherapy showed its effectiveness in the described case of inoperable HCC and allowed the patient to continue living, working, and leading an active lifestyle for more than 18 months.