Thyroid dysfunction with atezolizumab plus bevacizumab after lenvatinib in hepatocellular carcinoma: A case series

Abstract

Atezolizumab plus bevacizumab is the recommended first-line treatment for unresectable hepatocellular carcinoma, based on guidelines from the Barcelona Clinic Liver Cancer prognosis and treatment strategy. However, atezolizumab plus bevacizumab may be used after administration of lenvatinib. Here, we present four patients who developed thyroid dysfunction after second-line treatment with atezolizumab plus bevacizumab, but not after lenvatinib alone. The patients were treated with lenvatinib and/or atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma at Showa University Northern Yokohama Hospital. Of patients treated with only lenvatinib or atezolizumab plus bevacizumab, 2/18 (11%) and 4/15 (27%) developed thyroid dysfunction, respectively. All four patients treated with atezolizumab plus bevacizumab after lenvatinib developed hypothyroidism after 2–14 doses of atezolizumab plus bevacizumab. Three patients developed Grade 2 symptoms and were treated with levothyroxine sodium. In patients with hepatocellular carcinoma, the incidence of thyroid dysfunction may be higher among patients treated with atezolizumab plus bevacizumab after lenvatinib than those treated with lenvatinib or atezolizumab plus bevacizumab alone.

Prognostic Factors and Construction of Nomogram Prediction Model of Lung Cancer Patients Using Clinical and Blood Laboratory Parameters

“…Moreover, during the treatment process, drug metabolism and toxicity are associated with the liver and kidneys, 22 prompting the collection of liver and kidney indicators. As LC is a systemic disease, it may also trigger a systemic inflammatory response 23. Studies suggest that the occurrence of thyroid dysfunction may be higher in LC patients, 24 leading to the collection of thyroid function indicators. Additionally, research proposes that LC patients may exhibit abnormal coagulation enzyme activity, possibly related to the tumor itself or changes in the anticoagulation mechanism.…”

Immune-Related Adverse Events Associated with Atezolizumab: Insights from Real-World Pharmacovigilance Data

“…Disorders of the thyroid are common following immunotherapy and have been found to show a favourable outcome in hepatocellular carcinoma following atezolizumab treatment [ 31 ]. The incidence of hyperthyroidism and hypothyroidism following anti-PD-L1 therapy is reported to be 0.7% and 3.8–5.5%, respectively, and multiple cases of thyroid disorder post-atezolizumab have been reported [ 32 , 33 , 34 ]. Type 1 diabetes mellitus is an underreported and serious irAE if untreated, leading some patients to present with diabetic ketoacidosis [ 35 ].…”