背景:阿替珠单抗/贝伐单抗联合治疗成为晚期肝细胞癌(HCC)的一线治疗。治疗前应监测和管理胃食管静脉曲张。含贝伐单抗治疗期间门静脉高压的进展尚不清楚。
方法:一例新发的食管静脉曲张,腹水,据报道,台湾大学医院阿替珠单抗/贝伐单抗治疗期间出现肝性胸腔积液,并对相关文献进行了综述。
结果:我们介绍了一名83岁男性,乙型肝炎已解决,无肝硬化。他患有BCLCC期HCC,并接受三周阿妥珠单抗/贝伐单抗治疗34个周期,持续部分缓解。进行性腹水,食管静脉曲张,肝性胸水发展,尽管他的门静脉通畅,肿瘤也得到了控制。先前报道了5例类似的HCC病例(BCLCB/C:n=3/2)。其中,其中3人在治疗前患有肝硬化并预先存在小的食管静脉曲张.在给予阿替珠单抗/贝伐单抗治疗1-15个周期后,一名患者静脉曲张进展,另外4人出现静脉曲张出血.阿妥珠单抗/贝伐单抗与门静脉高压之间的关联是可能的,这可能与VEGF途径和免疫相关的不良事件与进行性肝纤维化有关。
结论:阿替珠单抗/贝伐单抗治疗可能会加剧门静脉高压。治疗期间应考虑仔细的监测和管理。
BACKGROUND: Atezolizumab/bevacizumab combination therapy became the first-line therapy for advanced hepatocellular carcinoma (HCC). Gastroesophageal
varices should be monitored and managed before treatment. The progression of portal hypertension during bevacizumab-containing therapy is unclear.
METHODS: A
case of new development of esophageal
varices, ascites, and hepatic hydrothorax during atezolizumab/bevacizumab therapy at National Taiwan University Hospital was reported, and relevant literature was reviewed.
RESULTS: We presented an 83-year-old male with resolved hepatitis B without cirrhosis. He had BCLC stage C HCC and received tri-weekly atezolizumab/bevacizumab therapy for 34 cycles with sustained partial response. Progressive ascites, esophageal
varices, and hepatic hydrothorax developed, though his portal vein was patent and the tumor was under control. Five similar cases of HCC (BCLC B/C: n = 3/2) had been reported previously. Among them, three had cirrhosis with pre-existing small esophageal
varices before treatment. After the administration of 1-15 cycles of atezolizumab/bevacizumab therapy, one patient had a progression of
varices, and the other four developed variceal bleeding. The association between atezolizumab/bevacizumab and portal hypertension was possible, which might relate to the VEGF pathway and immune-related adverse events with progressive hepatic fibrosis.
CONCLUSIONS: Atezolizumab/bevacizumab treatment might exacerbate portal hypertension. Careful monitoring and management should be considered during treatment.