Complete pathological remission after palliative therapy with sorafenib in hepatocellular carcinoma — case report

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver cancer. The five-year overall survival (OS) in men diagnosed with HCC does not exceed 9%. Patients (pts) with advanced disease are treated with sorafenib (multikinase inhibitor). In randomised trials the OS advantage was within the range of three months for sorafenib. Stabilisation of disease was achieved in 71% of patients, and no case of CR was reported. We present a case of 60-year-old patient with locally advanced cT3aN0M0 (stage IIIA according to seventh TNM) bifocal HCC (12 × 10 cm and 10 × 8 cm). The diagnosis was confirmed by pathologic examination. Due to the clinical stage, palliative treatment with sorafenib was administered from January 2016 to February 2017. A clinical partial response (cPR) enabled surgery. In May 2017, left-sided liver bisegmentomy and resection of residual lesion in segment 6 were performed. The pathological report revealed ypCR. Subsequently, pathology verification changed the primary diagnosis to PR. In September 2017 thermoablation of lesion in segment 5 of the liver was performed. The increased AFP (alpha-fetoprotein) level at baseline was normalised during treatment. The sorafenib therapy was completed after one year. The patient remains in follow-up with no evidence of relapse. Treatment with sorafenib in the presented case enabled radical therapy, so the palliative treatment turned out to be an induction treatment. Clinical CR (especially pCR) in advanced non-operable solid tumours after systemic treatment is quite rare (3-15%), and even less common in HCC. So far, only a few cases of achievement of CR during sorafenib therapy in HCC have been described.

New Opportunities in the Systemic Treatment of Hepatocellular Carcinoma—Today and Tomorrow

“…Moreover, the ALICE-1 study suggested that genetics may play an important role in the response to sorafenib, as certain genotypes within VEGF polymorphisms are associated with a significantly higher OS [32]. Despite unsatisfactory responsive rates observed in clinical trials, rare case reports describe patients who achieved a significant tumor size reduction, in whom surgical approach became feasible [33,34]. Nevertheless, in a large retrospective analysis by Rimola et al, out of 1119 HCC patients treated with sorafenib, only 12 (1%) were finally classified as complete responders.…”