The combination therapy of atezolizumab and bevacizumab is effective for unresectable hepatocellular carcinoma (HCC), while serious adverse effects can occasionally happen. Here we report a hepatitis B virus (HBV) infected patient with bevacizumab-related severe tumor hemorrhage of large HCC.

A man in his seventies was identified with HCC at the advanced stage of Barcelona Clinic Liver Cancer, and treated with atezolizumab and bevacizumab. Due to abdominal pain brought on by tumor hemorrhage and an inflammatory response, atezolizumab monotherapy was substituted for the combination therapy after the first dosage. Regardless of atezolizumab monotherapy, the disease progressed with no adverse events; thus, the patient was retreated with atezolizumab and bevacizumab. As anticipated, necrotic hemorrhage of the tumor with an inflammatory reaction recurred after the fourth administration as the same as the first one, resulting in the deterioration of the general condition and withdrawal treatment.

In the case of the combination of atezolizumab and bevacizumab therapy for HBV-related large HCC, treatment-related tumor hemorrhage may be crucial.

An 83-year-old male patient was admitted to our hospital due to anorexia and right hypochondriac pain. A huge hepatic tumor (14 cm in diameter) in the right lobe with right atrium invasion was detected on contrast-enhanced computed tomography and diagnosed as hepatocellular carcinoma (cStageIII, T3N0M0). Hepatic arterial infusion chemotherapy (New-FP treatment) was selected as the initial treatment. The right atrium invasion vanished and the tumor significantly shrunk after four courses of new-FP treatment. Transarterial chemoembolization+radiofrequency ablation (RFA) was subsequently administered thrice which achieved a complete response. The patient has had an uneventful course after the last RFA without recurrence for more than 1 year.

Hepatic arterial infusion chemotherapy is as effective as existing molecular-targeted drugs in advanced hepatocellular carcinoma with vascular invasion, and it is considered useful in patients with low-performance status such as this case.

Here, we report a rare case of liver metastasis that developed 13 months and 177 months after the resection of sigmoid colon cancer. A 78-year-old male patient underwent sigmoidectomy to treat moderately differentiated adenocarcinoma. Lateral segment hepatectomy was performed for liver metastasis after 13 months. We performed segmental resection because a tumor was found in the liver at segment 7 at 177 months after sigmoidectomy. A moderately differentiated tubular adenocarcinoma was found in postoperative pathological findings. The immunohistochemical examinations revealed CK7−/CK20+, and the patient was therefore diagnosed with liver metastasis from sigmoid colon cancer. Late recurrence of liver metastasis from colorectal cancer >10 years postoperatively is rare. However, the possibility of late remnant liver recurrence should be carefully examined if a liver tumor is found late after resection of hepatic colorectal metastasis, even if surveillance is completed.