Pseudoprogression in a patient with hepatocellular carcinoma treated with immunotherapy plus bevacizumab

A 62-year-old male with hepatocellular carcinoma on a healthy liver underwent surgery in April 2022. Five months after, the patient complained of abdominal pain, with an alpha-fetoprotein (AFP) level exceeding 9000 ng/ml, and CT images showed liver metastases and multiple lung metastases, so treatment with immunotherapy atezolizumab plus bevacizumab was started in September 2022. After four cycles, hyperprogression was observed in liver and lung metastases at first CT evaluation. However, abdominal pain improved, and AFP decrease, raising suspicion of pseudoprogression. Treatment was therefore continued until radiological progression could be confirmed with a follow-up CT scan after 2 months, which revealed a complete response of the pulmonary metastasis and a partial response of the liver metastasis.