Complete response for advanced liver cancer during sorafenib therapy: Case Report

Abstract

BackgroundHepatocellular carcinoma (HCC) is the fifth most common neoplasia in the world. In the past, treatment of advanced HCC with conventional antineoplastic drugs did not result in satisfactory outcomes: recently, in this patient population the oral multikinase inhibitor sorafenib has been able to induce a statistically significant improvement of overall survival. Similarly to other anti-angiogenic drugs employed in other tumour types, also sorafenib seldom induces the dimensional tumour shrinking usually observed with conventional cytotoxic drugs: data gathered from studies carried out with sorafenib and other competitors under development do not report any complete response in HCV-induced HCC.Case presentationAn 84-year old man with a long-lasting history of chronic HCV hepatitis was referred to our Institution for an ultrasonography investigation of a focal hepatic lesion. To better characterize the liver disease and clearly define the diagnosis of the focal hepatic lesion, the patient was hospitalized in our department. Laboratory and instrumental investigations confirmed the clinical picture of HCV-related liver cirrhosis and identified a hepatic lesion of about 6 cm featuring infiltrating HCC with thrombosis of the portal trunk. Due to the advanced stage of the disease, therapy with sorafenib 400 mg bid was started. Right from one month after the treatment was started, a reduction of alpha-fetoprotein level was observed which, by the third month, turned down within the normal limits. In addition the CT scan showed 50% reduction of the neoplastic lesion along with canalization of the portal trunk. At the sixth month the normalization of the alpha-fetoprotein level at the lower limit of normality was confirmed and the MRI showed complete disappearance of the neoplasia. In addition a reduction of a metallo-proteinase serum level was obserdved. At the twelfth month a further MRI confirmed complete response had been maintained. At present the patient is in a follow-up program to evaluate the duration of the complete response.ConclusionsThis case is worth mentioning since, to the best of our knowledge, it represents the first evidence of complete response to sorafenib in an elderly patient with advanced HCV-related HCC.

Sudden cardiac death in a patient with advanced hepatocellular carcinoma with good response to sorafenib treatment: A case report with literature analysis

“…Sorafenib proved to be effective against portal neoplastic thrombosis through the inhibition of the VEGF cascade (29). The partial recanalization of the portal venous system corroborates the hypothesis that sorafenib has a direct action on tumor cells invading the portal system and a modulation effect on the production of pro-thrombotic cytokines by the neoplastic cells (18,30). From the imaging point of view, as also described by other authors (31,32), in the present study a marked response to treatment in a highly enhancing lesion was observed.…”

“…The partial response (PR) rate in the sorafenib group was 2.0 vs. 1.0% (SHARP) and 3.3 vs. 1.3% (Asia-Pacific) compared with the placebo group (6,7). Only ten case reports of advanced HCC revealing a complete response (CR)/PR to sorafenib monotherapy are present in the literature, published between 2008 and 2011 (Table I) (14)(15)(16)(17)(18)(19). In a multicenter study published in 2014 by Shiba et al, only 18 of 3,047 (0.6%) patients who were administered sorafenib monotherapy at institutions belonging to the Liver Cancer Study Group of Japan obtained a CR (20).…”

Impact of pretreatment serum cholinesterase level in unresectable advanced hepatocellular carcinoma patients treated with sorafenib

“…In addition, we have previously treated a patient with advanced HCC with lung metastasis who achieved CR with sorafenib (29). These results suggest that a number of patients may achieve an objective response with sorafenib therapy (27)(28)(29)(30). However, characteristics of the patients benefiting from, as well as features associated with sorafenib-resistance have yet to be elucidated.…”

A Complete Response Induced by 21-day Sorafenib Therapy in a Patient with Advanced Hepatocellular Carcinoma

“…Sorafenib therapy did not achieve a complete response in 299 patients in the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) study or 150 patients in the Asian Pacific study; the partial response rates were 2.0% and 3.3%, respectively (6,7). Only a few studies have reported a complete response in HCC patients receiving sorafenib treatment (8)(9)(10)(11)(12)(13)(14)(15)(16). We listed these in order of the time to cessation (Table).…”