Complete and Sustained Off-Therapy Response to Sorafenib in Advanced Hepatocellular Carcinoma

Abstract

A 75-year-old Caucasian woman with alcohol-related cirrhosis was admitted to our Unit in October 2012 for the diagnostic evaluation of a focal liver lesion detected by regular surveillance ultrasound. Her medical history included heavy smoking (about 40 cigarettes/ day), hypertension, and chronic obstructive pulmonary disease diagnosed several years before.Upon admission the patient was asymptomatic and there was no evidence of hepatic encephalopathy, ascites or peripheral edema. Physical examination was unremarkable, except for hepatosplenomegaly. CASE REPORT ABSTRACTA 75-year-old Caucasian woman with alcohol-related cirrhosis was admitted to our Unit in October 2012 for the diagnostic evaluation of a focal liver lesion detected by regular surveillance ultrasound. The subsequent dynamic CT and MR led to a diagnosis of infiltrative hepatocellular carcinoma (HCC) of 5 cm in the hepatic segment IV with neoplastic infiltration of the left branch of the portal vein, in absence of extrahepatic metastases. Therapy with sorafenib 400 mg bid was started and the subsequent dynamic CT performed at the 10th month of therapy showed a complete response according to RECIST criteria and mRECIST, while seriated dosages of α-fetoprotein levels showed a progressive reduction up to normalization. After 18 months of therapy, Sorafenib was discontinued due to a grade 3 adverse event. Nonetheless, all subsequent radiological controls, performed over the following two years confirmed a complete off-therapy response despite withdrawal of Sorafenib. After three years the patient is asymptomatic, with a preserved liver function and undetectable solid tumor lesions at dynamic CT. This case represents one of the few examples of complete response to anti-angiogenic drugs and, to our knowledge, the only case of sustained response, even after the discontinuation of Sorafenib, described so far in the literature.

Complete Remission of Advanced Hepatocellular Carcinoma Treated with Sorafenib and Concomitant Appearance of IgG4- related Diseases. A Case Report

“…Characterizing the biological peculiarities of the tumor could help the identification of those characteristics that make one histological type more responsive to Sorafenib than another. However, according to the available guidelines [6,10], the diagnosis of HCC is based on the vascular behavior of lesions greater than one centimeter on imaging, whereas biopsies on HCC are less and less carried out, thus limiting biomarkers' evaluation as for the present report [11]. Recent studies have demonstrated that several biomarkers may help to predict a poor response to Sorafenib, such as a fast reduction in serum AFP while des-y-carboxyprothrombin levels following treatment predicts a good response to Sorafenib [12].…”

Observation of the effect of targeted therapy of 64-slice spiral CT combined with cryoablation for liver cancer

“…Its three-dimensional imaging technology enables physicians to view liver blood vessels and lesions that are more solid, clear, more accurate, and more comprehensive; allowing a reasonable needle puncture and optimizing the freezing effect[11,29,45,46]. Its rapid scan imaging during surgery allows the detection of the formation of ice ball and freezing conditions, provides an accurate lesion and surrounding tissue image, help in the timely adjustment of the ablation procedure, and prevents damage in surrounding tissues, while improving the effectiveness of tumor tissue ablation[9,35,47]. …”

Contrast-enhanced Ultrasound in the Assessment of the Transitional Zone of Microwave Ablations in an Ex vivo Perfused Liver Model; is It a Useful Tool?

“…The recommended guideline of ablation is to destroy cancerous lesions with a normal tissue circumferential safety margin of 5 mm to 10 mm to make sure that the whole lesion is treated [10,33]. After thermal ablation of a tumour, a hyperaemic rim appears which surrounds the ablated area [11,12]. The rim is not visible on grey-scale US, but contrast CT, MRI and CEUS show this rim as uniform, homogeneous, larger than the initial lesion in benign tumours, and irregular, with a size similar to the initial cancerous lesion if the ablation is not complete [10,13].…”

“…This is the zone where few cancer cells might escape heat leaving behind a residual tumour which consequently causes local recurrence. After ablation, the reactive tissue inflammation is shown as a hyperaemic rim surrounding the ablated zone [9,12]. This rim makes it difficult to differentiate between complete ablation and residual tumour [9][10][11][12][13].…”

“…After ablation, the reactive tissue inflammation is shown as a hyperaemic rim surrounding the ablated zone [9,12]. This rim makes it difficult to differentiate between complete ablation and residual tumour [9][10][11][12][13].…”