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\begin{document}

\title{Hepatocellular carcinoma with gastric adenocarcinoma treated with
atezolizumab and bevacizumab}



\author[1]{Takayoshi Suga}%
\author[1]{Yuko Kimura}%
\author[1]{Kensuke Furuya}%
\author[1]{Hiroko Sato}%
\affil[1]{Shibukawa Iryo Center}%


\vspace{-1em}



  
  \date{June 18, 2024}


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\selectlanguage{english}
\begin{abstract}
Hepatocellular carcinoma concurent with gastric adenocarcinoma is a rare
but possible case. In addition, selecting an effective treatment for two
primary cancers is often difficult. In this report, we present the first
case of hepatocellular carcinoma concurent with gastric adenocarcinoma
treated with atezolizumab and bevacizumab combination therapy.%
\end{abstract}%



\sloppy


\textbf{Hepatocellular carcinoma with gastric adenocarcinoma treated
with atezolizumab and bevacizumab}

Takayoshi Suga,\textsuperscript{1,2}* Yuko
Kimura,\textsuperscript{1,2}Kensuke Furuya,\textsuperscript{1,2} Hiroko
Sato,\textsuperscript{1,2}

1 Department of Gastroenterology, Shibukawa Medical Center, National
Hospital Organization, Shibukawa, Gunma, Japan.

2 Department of Gastroenterology and Hepatology, Gunma University
Graduate School of Medicine, Maebashi, Gunma, Japan.

\textbf{*Corresponding author} : Takayoshi Suga, M.D., Ph.D.,

Department of Gastroenterology, Shibukawa Medical Center, National
Hospital Organization, 383 Shirai, Shibukawa, Gunma 377-0280, Japan.

Tel: +81-279-23-1010

Fax: +81-279-23-1011

E-mail: jamosuga@yahoo.co.jp

\textbf{Conflict of interest} : There are no conflicts of interest to
declare.

\textbf{Informed consent} : Written informed consent was obtained from
the patient to publish this report in accordance with the journal's
patient consent policy.

\textbf{Key words} : Liver cancer; Gastric cancer; Double cancer

\textbf{Word count for main text} : 244 words



\textbf{Case}

A 58-year-old man was referred to our hospital for liver and gastric
tumors. Abdominal contrast-enhanced computed tomography (CT) revealed
low-density masses in the liver (Figure 1A, arrow) and stomach (Figure
1A, arrow head) with left supraclavicular lymph node metastasis. Upper
gastrointestinal endoscopy revealed an ulcerous mass lesion in the
gastric cardia (Figure 1B). The pathological diagnosis by liver biopsy
was hepatocellular carcinoma and by gastrointestinal endoscopic biopsy
was adenocarcinoma, showing programmed death-ligand 1 (PD-L1)-positive
and human epidermal growth factor receptor 2 (HER2)-negative findings.
Systemic chemotherapy for hepatocellular carcinoma was selected because
the hepatic tumor was huge and thought to contribute to the patient's
prognosis more than advanced gastric cancer. The patient was treated
with atezolizumab and bevacizumab combination therapy, the first line
treatment for hepatocellular carcinoma (1). Eighteen months after
treatment, CT showed partial response of hepatocellular carcinoma
(Figure 1C, arrow) and gastric adenocarcinoma (Figure 1C, arrow head).
No tumor growth was observed on gastrointestinal endoscopy (Figure 1D).

To our knowledge, this is the first report that atezolizumab and
bevacizumab combination therapy was effective in a patient with two
primary cancers, namely, hepatocellular carcinoma and gastric
adenocarcinoma. However, whether anti-PD-L1 antibody atezolizumab had
any effect on gastric cancer in this case is controversial, and
bevacizumab has been reported to have some effects (2)(3)(4). Therefore,
selecting an effective treatment for two primary cancers is often
difficult. Atezolizumab and bevacizumab combination therapy might be one
of the treatment options for hepatocellular carcinoma concurrent with
gastric adenocarcinoma.

\textbf{REFERENCES}

\begin{enumerate}
\tightlist
\item
  Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus Bevacizumab in
  Unresectable Hepatocellular Carcinoma. N Engl J Med.
  2020;382(20):1894-1905.
\item
  H\selectlanguage{ngerman}ögner A, Moehler M. Immunotherapy in Gastric Cancer. Curr Oncol.
  2022;29(3):1559-1574.
\item
  Xie J, Fu L, Jin L. Immunotherapy of gastric cancer: Past, future
  perspective and challenges. Pathol Res Pract. 2021;218:153322.
\item
  Ohtsu A, Shah MA, Van Cutsem E, et al. Bevacizumab in combination with
  chemotherapy as first-line therapy in advanced gastric cancer: a
  randomized, double-blind, placebo-controlled phase III study. J Clin
  Oncol. 2011;29(30):3968-3976.
\end{enumerate}

\textbf{Figure legend}

Figure 1. Computed tomography of hepatic and gastric masses before (A)
and after (C) treatment. Endoscopy with gastric tumor before (B) and
after (D) treatment.\selectlanguage{english}
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