Prolonged Survival with Atezolizumab–Bevacizumab and Transarterial Chemoembolization in Unresectable Fibrolamellar Hepatocellular Carcinoma: A Case Report

Fibrolamellar hepatocellular carcinoma (FLC) is a rare liver malignancy typically affecting young adults without underlying liver disease. The case presented here explores the efficacy of combining transarterial chemoembolization (TACE) with immunotherapy and anti-angiogenic therapy. A 20-year-old woman presented with diffuse abdominal pain, nausea, and vomiting. Imaging revealed a large hepatic mass measuring 181 mm, and multiple pulmonary nodules. Histopathological examination confirmed well-differentiated, unresectable FLC. Systemic treatment with atezolizumab and bevacizumab was considered appropriate; however, delays due to its off-label status in FLC led to the use of TACE as a bridging intervention. Three sessions of TACE were completed prior to the initiation of immunotherapy, which was subsequently administered for 22 cycles. Although radiological criteria for partial response according to RECIST 1.1 were not met, a 26.7% reduction in tumor size was observed, along with stability of pulmonary lesions. The patient achieved a progression-free survival of 18.13 months and an overall survival of 22.23 months. These findings highlight the potential of a combined locoregional and systemic approach in the management of unresectable FLC, and represent the first reported case of this strategy in Mexico.Further investigation into immunotherapy-based, multimodal regimens is warranted, highlighting the importance of collaborative efforts to improve outcomes in rare hepatic malignancies.