# Tumor Rupture in a Patient with Recurrent Hepatocellular Carcinoma Following Atezolizumab plus Bevacizumab: A Case Report

## TL;DR

A patient with liver cancer experienced a rare tumor rupture after receiving atezolizumab and bevacizumab, which was successfully treated with arterial embolization.

## Contribution

This is the first reported case of HCC rupture following atezolizumab plus bevacizumab therapy.

## Key findings

- Tumor rupture occurred in a patient with recurrent HCC after the first cycle of atezo-bev.
- The patient was successfully managed with transcatheter arterial embolization.
- No further tumor bleeding occurred after resuming atezo-bev treatment.

## Abstract

Atezolizumab plus bevacizumab combination therapy (atezo-bev) has been widely used worldwide as the first-line treatment for unresectable hepatocellular carcinoma (HCC). Intratumoral hemorrhage has been reported as a rare adverse event of atezo-bev. However, no previous cases of HCC rupture during atezo-bev have been reported. Herein, we demonstrate a case of tumor rupture in a patient with recurrent HCC following atezo-bev, who was successfully managed with transcatheter arterial embolization (TAE).

An 80-year-old man with multiple recurrent HCCs (at least 4 lesions with a maximum tumor diameter of 35 mm protruding from the liver surface) developed epigastralgia immediately after the first cycle of atezo-bev. CT revealed a ruptured HCC in the left lateral lobe. TAE was performed, and the patient continued to receive atezo-bev without any subsequent tumor bleeding.

Tumor rupture should be considered in patients with HCC following atezo-bev treatment.