Complete Response after Short-Term Sorafenib Treatment in a Patient with Lymph Node Metastasis of Hepatocellular Carcinoma

Abstract

A 60-year-old man received interferon/ribavirin combination therapy for chronic hepatitis C in 2002 and achieved sustained virological response. In 2008, a hepatocellular carcinoma (HCC) with a diameter of 60 mm appeared and surgical resection was performed. In March 2011, the patient was referred to our hospital because of portal lymph node swelling. Abdominal ultrasonography, dynamic CT and dynamic MRI did not show any tumors in the liver, but revealed portal lymph node swelling (18 × 11 mm). Taking the elevation of serum des-γ-carboxy prothrombin and alpha-fetoprotein levels, including the lectin-bound type, into consideration, we made the diagnosis of HCC metastasis to the portal lymph node. We started sorafenib therapy at a dose of 800 mg/day, but discontinued it after 11 days due to grade 3 hand-foot skin reaction and rash. In spite of treatment termination, portal lymph node swelling disappeared and the serum des-γ-carboxy prothrombin and alpha-fetoprotein levels normalized. We considered that our patient achieved complete response to sorafenib according to the Response Evaluation Criteria in Solid Tumors (RECIST). The patient maintains remission up to June 2012, more than 1 year after the discontinuation of sorafenib therapy. Sorafenib could be a good option for unresectable or recurrent HCC.

Serial changes of clinical parameters in a patient with advanced hepatocellular carcinoma with portal vein thrombosis achieving complete response after treatment with sorafenib

“…In addition, our case demonstrated a significant decreasing linear trend after log transformation. Some studies have also reported a rapid decrease in AFP levels, but this characteristic was not further analyzed 7–11,13–15. In the current case, the calculated half-life of AFP level was 6.84 days, which was similar to that reported in the previous studies 7–11,13–15.…”

“…This indicates that sorafenib is effective in some HCC patients despite a low-dose administration. In some patients, there has been no recurrence of HCC despite cessation of sorafenib 9,11…”

Complete response to short‐term sorafenib treatment alone for hepatocellular carcinoma with bone, lymph node, and peritoneum metastases

“…Complete response to sorafenib has been reported previously in 40 case reports of patients with advanced HCC . Complete response to sorafenib in patients with bone metastasis is rare.…”

“…1,2 Complete response to sorafenib has been reported previously in 40 case reports of patients with advanced HCC. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Complete response to sorafenib in patients with bone metastasis is rare. In this case report, we describe CR to short-term sorafenib treatment in a patient with HCC and bone, lymph node, and peritoneal metastases.…”

Deteriorated portal flow may cause liver failure in patients with hepatocellular carcinoma being treated with sorafenib

“…One had portal vein tumor thrombus (PVTT) and the other developed portal vein thrombosis (PVT) during the treatment. Although both PVTT and PVT are regarded as negative prognostic factors for patients with HCC, previous studies have identified several patients with deteriorated portal flow who achieved complete remission (CR) while being treated with sorafenib (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). We hypothesized that the pathogenesis of disease may be similar in HCC patients who achieve CR and those who experience liver failure while on sorafenib.…”