A case report: Long-term complete response of metastatic hepatocellular carcinoma obtained after discontinuation of 2-mo
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CASE REPORT
A case report: Long‑term complete response of metastatic hepatocellular carcinoma obtained after discontinuation of 2‑month sorafenib monotherapy Suguru Hirose1 · Kazunori Ishige1 · Masamichi Yamaura1 · Tsuneo Mizui1 · Yoshiki Komatsu1 · Masaomi Nagase1 · Masashi Sato1 · Junji Hattori1 · Masato Endo1 · Naoyuki Hasegawa1 · Kuniaki Fukuda1 · Ichinosuke Hyodo1 Received: 3 February 2020 / Accepted: 29 May 2020 © Japanese Society of Gastroenterology 2020
Abstract A 69-year-old woman who had a history of chronic hepatitis C, autoimmune hemolytic anemia and myelodysplastic syndrome was treated with sorafenib at a daily dose of 400 mg for HCC with multiple lung metastases. Nonetheless, elevated serum tumor markers further increased (alpha fetoprotein from 121,100 to 348,660 ng/ml and protein induced by vitamin K absence/antagonist-II from 3435 to 29,357 mAU/ml), and lung metastatic lesions on chest X-ray showed no improvement after 2 months of sorafenib treatment. Sorafenib was discontinued because of adverse events with diarrhea, fatigue, and severe anemia due to bleeding from stomach telangiectasia. Hand–foot syndrome was mild. Thereafter, the tumor markers rapidly decreased to almost normal range, and the lung and liver tumors markedly shrunk and disappeared without any other cancer treatments. Her tumors remained in complete remission for 17 months until an intrahepatic recurrence occurred. This unique course of metastatic HCC indicated that antitumor mechanisms other than the direct anticancer effect of sorafenib contributed to tumor shrinkage. Keywords Hepatocellular carcinoma · Lung metastases · Sorafenib · Complete remission
Introduction Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide [1]. The majority of patients with HCC are diagnosed with advanced disease unsuitable for curative locoregional therapies [2]. Sorafenib is an oral multi-kinase inhibitor used for the treatment of advanced HCC. The Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial showed prolongation of overall survival and progressionfree survival in patients with advanced HCC treated with sorafenib [3]. However, the response rate according to the Response Evaluation Criteria in Solid Tumors (RECIST) was relatively low (2%), and no complete response (CR) cases were reported. Based on a recent report, the CR rate * Kazunori Ishige ishige‑[email protected] 1
Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
for patients treated with sorafenib alone is approximately 1% [4]. Among reported CR cases, the majority showed a rapid decrease in serum tumor marker levels and tumor size following sorafenib treatment. Here we report a unique case of an HCC patient with multiple lung metastases who showed no response during 2 months of sorafenib treatment but achieved a durable CR after treatment discontinuation.
Case report A 69-year-old woman with chronic hepatitis C received transcatheter arterial chemo
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