A clinical case of prolonged response to therapy for advanced hepatocellular carcinoma

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer mortality in the world, especially in regions with a high prevalence of viral hepatitis and cirrhosis of the liver. Systemic treatments remain the standard of treatment for common HCC. The most significant breakthrough was the appearance of a combination of the PD-L1 inhibitor Atezolizumab and the antiangiogenic drug Bevacizumab, which showed superiority over the tyrosine kinase inhibitor Sorafenib in key studies. A clinical case of treatment of a 61-year-old patient with advanced HCC on the background of cirrhosis of the liver of viral etiology, thrombosis of the portal vein and inferior vena cava with extrahepatic foci is presented. At the first stage, Atezolizumab and Bevacizumab were treated according to the first-line treatment protocol. Despite the development of immune-mediated toxic hepatitis and clinically significant bleeding, which required temporary discontinuation of treatment, repeated administration of the drugs led to a long-term stabilization of the process, confirmed by data from subsequent X-ray control studies. The case illustrates the effectiveness of a combination of immunotargeting therapy, including in patients with severe concomitant pathology, as well as the importance of a multidisciplinary approach and flexibility in correcting emerging complications.