Short-Term Oral Sorafenib for Therapy of Intratumoral Shunts of Hepatocellular Carcinoma to Enable Intraarterial Treatment

Abstract

Introduction Significant intratumoral shunts between tumor-supplying arteries and portal or liver veins are a contraindication for transarterial therapy of HCC because interventional treatment of these shunts is frequently insufficient. Sorafenib has anti-angiogenic effects and is indicated for palliative treatment of patients with HCC. Here, we report our experience with the use of sorafenib for the closure of intratumoral shunts in patients scheduled for transarterial therapy of HCC. Materials and Methods Three patients with HCC, aged 65, 82 and 79 years, exhibited a significant intratumoral shunting from tumor artery to portal ( n = 1) or liver veins ( n = 2). In all cases, intratumoral shunting had already been suspected based on pre-interventional CT angiography, and DSA confirmed the shunt. Oral sorafenib (800 mg/day) was administered for at least four weeks, only and specifically to occlude the shunt. Hereafter, patients were re-evaluated by CT and DSA. Results All patients tolerated the full prescribed dose for at least 4 weeks. In one case, therapy was prolonged with an adapted dose (400 mg/day) due to sorafenib-related hand–foot syndrome. After sorafenib treatment, CT and DSA confirmed a complete closure of intratumoral shunts for all patients. No tumor progression was observed. All three patients hereafter underwent successful transarterial treatment by TACE ( n = 2) or TARE ( n = 1) without complications. Progression-free survival according to mRECIST was 501, 397 and 599 days, respectively. Conclusion Even short-term oral sorafenib seems to effectively close intratumoral shunts in patients with HCC and thus might enable transarterial treatment of these patients. Electronic supplementary material The online version of this article (10.1007/s00270-019-02294-7) contains supplementary material, which is available to authorized users.

Recognizing and Managing Adverse Events in Y-90 Radioembolization

“…Finally, pre-radioembolization administration of at least 4 weeks oral sorafenib, a multikinase inhibitor with antiangiogenic properties, has also been reported to successfully reduce lung shunt fraction without interval tumor progression. 30 Despite the low incidence of radiation-induced lung injury, providers should have a low threshold for chest radiography or CT if patients report dyspnea, cough, or chest pain after radioembolization. If ground-glass attenuation or consolidations are identified, functional testing can identify restrictive lung disease, and bronchioalveolar lavage or parenchymal biopsy can be considered to assess for alternative causes of lung disease.…”