Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

Abstract

Hepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

“…They observed that male patients tend to have higher rate of portal vein thrombosis. Portal vein thrombosis is a critical issue that can deteriorate the prognosis of HCC because it can lead to wide dissemination of tumors through the liver and cause a marked deterioration of hepatic function . The incidence of extra‐hepatic metastases has been reported in 19.66% in our studies and occurred mainly to the lungs.…”

Long-Term Survival under Arterial Chemoembolization and Sorafenib of a Patient with Hepatocellular Carcinoma and Tumor Atrial Thrombus: A Case Report and Literature Review

“…In conclusion, long-term survival in patients with HCC and RA TT has been mainly managed either by resection of tumor and TT alone [14,15,21,24,29] or, when surgery was not feasible, with other therapeutic approaches (sorafenib, TACE, systemic chemotherapy, ablation) [10,25,28]. However, long-term survival is also possible when nonsurgical therapeutic options are combined, as in our patient.…”

“…Hence, this treatment approach is implemented in patients with a general good health condition and in those with symptoms of congestive heart failure. However, the majority of patients with HCC have poor performance status and they are often not considered as surgical candidates [10]. Therefore, other treatment options including TACE, percutaneous microwave ablation, radiation therapy and systemic therapy with multikinase inhibitors, such as sorafenib, or immune checkpoint inhibitors, such as nivolumab, have also been used for these patients ( Table 1).…”

“…Based on the literature data (Table 1), the survival time for patients treated with sorafenib ranged from 2 to 17 months [10][11][12][13]. For patients treated with TACE the median survival time was 4.5 months, while for those who received no treatment it was 2-5 months [3,14].…”

“…Overview of case studies on the treatment and survival of patients with hepatocellular carcinoma and tumor atrial thrombus[2,4,7,10, …”