San Francisco Giants left-hander Jose Alvarez suffered a setback in his rehab and will likely require Tommy John surgery, the San Francisco Chronicle reported Thursday.

Alvarez, 33, hasn’t pitched since mid-June. He had two stints on the injured list, including one for elbow inflammation that turned out to be a strain of his ulnar collateral ligament (UCL), per the report.

Alvarez is expected to seek more opinions before making a decision.

He was 2-1 with a 5.28 ERA in 21 appearances for the Giants, last pitching June 11 against the Los Angeles Dodgers. He earned his first and only save of the season.

Alvarez is 22-25 with a 3.47 ERA in 447 career appearances (eight starts) for four teams, including the Los Angeles Angels (2014-18). He has four career saves.

–Field Level Media