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Hepatic encephalopathy, hand-foot syndrome and proteinuria: case report A 60-year-old woman developed hepatic encephalopathy during treatment with sorafenib, and hand-foot syndrome and proteinuria during treatment with lenvatinib for metastatic hepatocellular carcinoma [routes and frequencies not stated]. The woman, who had alcoholic cirrhosis, was diagnosed with hepatocellular carcinoma and had undergone partial hepatectomy. Due to the recurrent hepatocellular carcinoma, she received several locoregional and radiation therapies. However, she had elevated intrahepatic involvement and distant metastases of the carcinoma. Hence, she started receiving sorafenib 800mg (a molecular-targeted agent). Three days after the initiation of sorafenib, she developed severe hepatic encephalopathy. She also had underlying hyperammonaemia. The woman’s sorafenib dose was decreased to 400mg, and she received unspecified treatment. However, no improvement in encephalopathy was noted. Hence, sorafenib therapy was stopped. Thereafter, she experienced increase in the metastatic lesions and re-initiation of a molecular-targeted agent was considered. An examination showed a portosystemic shunt, which had developed secondary to portal hypertension with cirrhosis. Hence, shunt occlusion was performed prior to re-initiation of the molecular-targeted agent. Two weeks later, she started receiving lenvatinib 8mg. Subsequently, she developed lenvatinib-related adverse events including proteinuria and grade 2 hand-foot syndrome [duration of treatment to reactions onset not stated]. Hence, lenvatinib dose was reduced followed by temporary discontinuation. Later, the metastatic lesions reduced, and lenvatinib was continued without onset of hepatic encephalopathy or hyperammonaemia [not all outcomes stated]. Kuwahara A, et al. Shunt occlusion prior to lenvatinib administration prevents hepatic encephalopathy and hyperammonemia. JGH Open 4: 775-776, No. 4, Aug 2020. Available from: URL: http://doi.org/10.1002/jgh3.12351 803501883

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Reactions 19 Sep 2020 No. 1822