The impact of atezolizumab and bevacizumab in hepatocellular carcinoma with activated ß‐catenin signaling

BACKGROUND: To date, no biomarkers exist to predict response or resistance to immunotherapy in hepatocellular carcinoma (HCC). Recent approaches to classify HCC into different immunological states revealed a negative correlation between Wnt/ß‐catenin activation and immunogenicity and T‐cell infiltration. If these “cold” tumors with primary resistance to checkpoint inhibition (CPI) may benefit from dual treatment of CPI and anti‐angiogenic therapy has not been proved. CASE: Here, we describe the case of a male patient with metastatic HCC. After failure of standard of care treatment with lenvatinib, sorafenib and ramucirumab fourth‐line systemic therapy with atezolizumab and bevacizumab were applied leading to a phenomenal response. Immunohistochemical evaluations were compatible with Wnt/ß‐catenin pathway activation and accompanying low T‐cell infiltration as well as low PD‐L1 score. CONCLUSION: Patients with Wnt/ß‐catenin activation may benefit from combination therapy with atezolizumab and bevacizumab regardless of potential predictive markers for immune checkpoint inhibition.