Korean J Gastroenterol.  2015 Apr;65(4):246-251. 10.4166/kjg.2015.65.4.246.

Sorafenib in the Treatment of Recurrent Hepatocellular Carcinoma after Liver Transplantation: A Report of Four Cases

• Hong YM
• Yoon KT
• Cho M
• Kang DH
• Kim HW
• Choi CW
• Park SB
• Heo J
• Woo HY
• Lim W

• KMID: 2373217
• DOI: http://doi.org/10.4166/kjg.2015.65.4.246

Abstract

With an increasing number of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT), tumor recurrence remains the main limiting factor for long-term survival. Although sorafenib is available for advanced HCC, there is still a lack of data on the use of sorafenib for treatment of recurrent HCC after LT. Here, we report on four cases of the use of sorafenib for treatment of recurrent HCC after LT. The median time of recurrence from LT was 4 months (range, 1-16 months). Two of the four evaluated patients showed stable disease, which was the best response and the duration of stabilization was 11 months and 5 months, respectively. One patient also experienced stable disease and remained in stable disease without sorafenib therapy for 29 months and the total duration of stabilization was 38 months. The remaining patient showed partial response but stopped treatment due to radiological tumor progression during treatment. Although all cases were high risk group for recurrence such as above Milan criteria, vascular invasion and tumor biology, clinical outcomes showed some good results. Therefore, sorafenib may be an acceptable treatment option for recurrent HCC after LT.

Keyword

Hepatocellular carcinoma; Liver transplantation; Recurrence; Sorafenib

MeSH Terms

Antineoplastic Agents/*therapeutic use
Carcinoma, Hepatocellular/diagnosis/*drug therapy
Female
Humans
Liver Neoplasms/diagnosis/*drug therapy
*Liver Transplantation
Male
Middle Aged
Neoplasm Recurrence, Local
Niacinamide/*analogs & derivatives/therapeutic use
Phenylurea Compounds/*therapeutic use
Positron-Emission Tomography
Tomography, X-Ray Computed
Antineoplastic Agents
Niacinamide
Phenylurea Compounds

Figure

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  Fig. 1. (A-D) The radiologic features of Case 1. (A, B) Chest CT showed multiple lung nodules on both lobes (arrows) before sorafenib treatment.(C, D) Two months after sorafenib administration, chest CT showed that the majority of variable sized multiple nodules on both lungs (arrows) had disappeared and some indeterminate nodules remained. (E-H) The radiologic features of Case 2. Chest CT (E, F) showed a 19 mm sized dense round nodule (arrows) in the right lower lobe (RLL) and a 3 mm sized indeterminate nodule in the left upper lobe (LUL). (G) PET-CT also showed a hypermetabolic nodule (SUVmax 3.4) on RLL (arrow). (H) Two months after sorafenib administration, chest CT showed no interval change of lung nodule in LUL (arrow).

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  Fig. 2. (A-D) The radiologic features of Case 3. (A, B) Chest CT showed variable sized multiple nodules on both lungs (largest, 12 mm) (arrows) before sorafenib treatment. (C, D) Five months after sorafenib administration, chest CT revealed that several variable sized multiple nodules on both lungs had decreased and some nodules remained (arrows). (E-H) The radiologic features of Case 4. (E) Abdomen CT showed an enhancing mass (4.0×2.9 cm) at the right acetabulum. (F, G) Bone scan and PET-CT also showed bone metastasis in the right pelvic bone. (H) Three month after sorafenib administration, abdomen CT showed interval decrease in the size of metastasis at the right acetabulum.

Reference

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