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CASE REPORT article

Front. Med.
Sec. Hepatobiliary Diseases
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1461127
This article is part of the Research Topic Immunological Aspects of Fibrosis Pathogenesis: Novel Mechanisms and Therapeutic Strategies View all 5 articles

The efficacy of adding high doses of intravenous vitamin C to the combination therapy of atezolizumab and bevacizumab in unresectable HCC

Provisionally accepted
Waleed Kian Waleed Kian 1,2,3*Areen Abu Remilah Areen Abu Remilah 3Celine Shatat Celine Shatat 1Maria Spector Maria Spector 4Laila C. Roisman Laila C. Roisman 3Larisa Rivo Larisa Rivo 1,2
  • 1 The Institute of Oncology, Assuta Ashdod, Ashdod, Israel, Ashdod, Israel
  • 2 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
  • 3 The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel, Jerusalem, Jerusalem, Israel
  • 4 The Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel., Jerusalem, Israel

The final, formatted version of the article will be published soon.

    Introduction: Vitamin C (L-ascorbic acid) plays a vital role in human physiology, serving as both an antioxidant and a cofactor in enzymatic reactions. High-dose intravenous Vitamin C can achieve significantly elevated plasma concentrations, potentially enhancing its anticancer effects. This case study explores the synergistic impact of high-dose intravenous Vitamin C in combination with Bevacizumab and Atezolizumab in the treatment of a patient with unresectable hepatocellular carcinoma (HCC). Case Presentation: A 68-year-old male was diagnosed with unresectable HCC, presenting with elevated liver enzymes and an alpha-fetoprotein (AFP) level of 2018 ng/mL. Initial treatment with Atezolizumab and Bevacizumab commenced in February 2022. Although imaging indicated stable disease, AFP levels decreased modestly to 1526 ng/mL, while liver function tests remained elevated, accompanied by further clinical deterioration and weight loss. Subsequently, intravenous Vitamin C (30 grams) was introduced into the treatment regimen. This addition led to a rapid and significant reduction in AFP levels, normalization of liver function tests, and marked improvement in clinical symptoms. The patient continued on this combined regimen of Vitamin C, Atezolizumab, and Bevacizumab. Four months later, CT scans revealed significant tumor shrinkage and necrosis. As of thirty months post-diagnosis, the patient remains on the regimen with normal liver function and an AFP level of 1.8 ng/mL, maintaining normal activities and stable weight. Conclusion: To our knowledge, this is the first reported case of combining high-dose intravenous vitamin C with Bevacizumab and Atezolizumab, which proved to be safe and resulted in significant clinical and radiological improvements in unresectable hepatocellular carcinoma (HCC). Further studies are recommended to explore the potential of this combination therapy.

    Keywords: vitamin C, Ascorbic Acid, Hepatocellular Carcinoma, liver cancer, atezolizumab, bevacizumab

    Received: 07 Jul 2024; Accepted: 18 Sep 2024.

    Copyright: © 2024 Kian, Abu Remilah, Shatat, Spector, Roisman and Rivo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Waleed Kian, The Institute of Oncology, Assuta Ashdod, Ashdod, Israel, Ashdod, Israel

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.