Polymyalgia rheumatica during combination therapy with atezolizumab plus bevacizumab for advanced hepatocellular carcinoma

• DOI: 10.1007/s12328-023-01800-2
• Publication Date: 2023-04-18T10:04:04Z
• Authors: Naoki Dosoden; Teiji Kuzuya; Yumi Ito; Jo Nishino; Eizaburo Ohno; Naoto Kawabe; Senju Hashimoto; Yoshiki Hirooka; Hidekata Yasuoka
• Keywords: Bevacizumab; Carcinoma, Hepatocellular; C-Reactive Protein; Polymyalgia Rheumatica; Prednisolone; Liver Neoplasms; Humans; 3. Good health

The combination therapy of atezolizumab, an anti-programmed cell death ligand-1 antibody, plus bevacizumab (Atz/Bev) is widely used to treat patients with advanced hepatocellular carcinoma (HCC). The development of polymyalgia rheumatica (PMR) during immune checkpoint inhibitor therapy for patients with HCC has not been reported to date. Two patients who developed PMR during Atz/Bev therapy for advanced HCC are reported. Both patients developed fever, bilateral symmetrical shoulder pain, morning stiffness, and an elevated C-reactive protein level. Their symptoms improved rapidly with prednisolone (PSL) 15-20 mg/d, and their C-reactive protein levels decreased. In PMR, long-term low-dose PSL should be administered. In the present patients who developed PMR as immune-related adverse events, starting with a small dose of PSL resulted in rapid improvement of symptoms.