Case of hepatocellular carcinoma with adrenocortical insufficiency following combination treatment of atezolizumab and bevacizumab

Abstract

A 70-year-old man with cirrhosis-sustained viral response following treatment for HCV (Child-Pugh class A) had two distinct treatment histories for single hepatocellular carcinoma (HCC) by radiofrequency ablation. A combination of atezolizumab and bevacizumab was initiated for treatment of HCC with lymph node metastasis. After seven treatment courses, he complained of nausea, malaise, and anorexia; laboratory data revealed eosinophilia. Furthermore, hormonal examination revealed hypopituitarism or hypothalamic adrenocortical insufficiency. Following hydrocortisone administration, the symptoms vanished and eosinophil counts normalized. Under continuous hydrocortisone administration, atezolizumab and bevacizumab was administered for 34 courses without persistent adrenal insufficiency, which was followed by three courses of durvalumab and tremelimumab combination therapy; subsequently cabozantinib was administered. Although hypoadrenalism is a relatively rare immune-related adverse event with non-specific symptoms, eosinophil count may serve as a useful marker. Furthermore, immune checkpoint inhibitors can be continued following appropriate corticosteroid administration.