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Background <p>Atezolizumab plus bevacizumab (ATZ + BV) is the standard first-line therapy for unresectable hepatocellular carcinoma (HCC). However, long-term treatment is frequently limited by adverse events such as proteinuria and hypertension, often resulting in treatment interruption or discontinuation. Evidence regarding the feasibility of dose modification, particularly half-dose BV, remains limited.</p> Case presentation <p>We report a patient with unresectable HCC who responded favorably to ATZ + BV but developed significant proteinuria (&gt;&#xa0;2&#xa0;g/day) after several cycles. To manage this toxicity, BV was reduced to half the standard dose while continuing full-dose ATZ. Following dose modification, proteinuria stabilized, and systemic therapy was maintained for more than 3&#xa0;years. During follow-up, the patient underwent gastrectomy for gastric cancer, at which time a peritoneal metastatic lesion of HCC was also resected. Histopathological examination revealed complete absence of viable tumor cells, confirming a pathological complete response (pCR). Of note, in our institutional experience with more than 70 patients treated with ATZ + BV, several also required BV half-dose, and long-term disease control was observed, supporting the reproducibility of this approach.</p> Conclusion <p>This case suggests that reducing the BV dose to half of the standard level may allow continued ATZ + BV therapy without loss of efficacy. Furthermore, the achievement of pCR in a resected peritoneal metastasis underscores the potential of this management strategy for durable disease control in unresectable HCC.</p>

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Durable disease control in unresectable hepatocellular carcinoma with atezolizumab plus half-dose bevacizumab: pathological complete response of peritoneal metastasis

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Haruki Mori,
  • Hiromitsu Maehira,
  • Nobuhito Nitta,
  • Shiori Fujimoto,
  • Takeru Maekawa,
  • Toru Miyake,
  • Sachiko Kaida,
  • Katsushi Takebayashi,
  • Takeshi Sonoda,
  • Masaji Tani

摘要

Background

Atezolizumab plus bevacizumab (ATZ + BV) is the standard first-line therapy for unresectable hepatocellular carcinoma (HCC). However, long-term treatment is frequently limited by adverse events such as proteinuria and hypertension, often resulting in treatment interruption or discontinuation. Evidence regarding the feasibility of dose modification, particularly half-dose BV, remains limited.

Case presentation

We report a patient with unresectable HCC who responded favorably to ATZ + BV but developed significant proteinuria (> 2 g/day) after several cycles. To manage this toxicity, BV was reduced to half the standard dose while continuing full-dose ATZ. Following dose modification, proteinuria stabilized, and systemic therapy was maintained for more than 3 years. During follow-up, the patient underwent gastrectomy for gastric cancer, at which time a peritoneal metastatic lesion of HCC was also resected. Histopathological examination revealed complete absence of viable tumor cells, confirming a pathological complete response (pCR). Of note, in our institutional experience with more than 70 patients treated with ATZ + BV, several also required BV half-dose, and long-term disease control was observed, supporting the reproducibility of this approach.

Conclusion

This case suggests that reducing the BV dose to half of the standard level may allow continued ATZ + BV therapy without loss of efficacy. Furthermore, the achievement of pCR in a resected peritoneal metastasis underscores the potential of this management strategy for durable disease control in unresectable HCC.