CHSU Discovery

Abstract:

Introduction: Cirrhosis and its progression to HCC is a major complication associated with HCV virus infection, with significant mortality and morbidity rate. TIPS is indicated to treat portal HTN leading to uncontrolled hemorrhage from esophageal or intestinal varices, or portal HTN gastropathy. Surgery to remove the tumor or a liver transplant are the best option for cure, if not an option ‘atezolizumab plus bevacizumab’ is recommended and if unable to receive bevacizumab, ‘tremelimumab plus durvalumab’ is an alternative. Surgery to remove the tumor or a liver transplant are the best option for cure, if not an option ‘atezolizumab plus bevacizumab’ is recommended and if unable to receive bevacizumab, ‘tremelimumab plus durvalumab’ is an alternative.

Discussion: Atezolizumab is a humanized monoclonal antibody immune checkpoint inhibitor that selectively binds to PD-L1 and blocks inhibitory signals related to T-cell activation. (Fig. A) Bevacizumab acts by selectively binding circulating VEGF to its cell surface receptors, leading to a reduction in microvascular growth of tumor blood vessels and thus limits the blood supply to tumor tissues. (Fig. B) Patient was initially on atezolizumab plus bevacizumab infusion, later switched to and currently on tremelimumab plus durvalumab. Patient is being evaluated for placement of TIPS at Fresno due to uncontrolled hemorrhage 2/2 variceal bleed and portal hypertensive gastropathy leading to multiple units of PRBC and platelets transfusion, octreotide infusions and endoscopic band ligations in the recent past.