Sorafenib from palliative to neoadjuvant chemotherapy in hepatocellular carcinoma with major vascular invasion: experience of two cases

Abstract

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the incidence is higher in cirrhosis. Treatment options depend on tumor stage, status of liver function, and the general condition of the patient. Major vascular invasion is a contraindication for liver transplantation. Sorafenib has been found to be useful in association with transarterial chemoembolization as an effective chemotherapeutic agent to prolong survival in inoperable HCCs. Here we describe our experience where sorafenib was used as palliation but later turned out to be a neoadjuvant. Both cases had major portal vein thrombosis and received sorafenib as palliative therapy. After a mean use of 6 months, both patients had marked tumor response and proceeded to have liver transplantations. Both cases are tumor-free at a median follow up of 13 months.

Keywords

Hepatocellular carcinoma / sorafenib / hepatic artery ligation / liver transplantation / major vascular invasion

References

[1] Marrero JA.Modern diagnosis and management of hepatocellular carcinoma..Clin Liver Dis2009;13:233-47

[2] Bhangui P,Vibert E,Pelletier G,Guettier C,Saliba F,Samuel D,Adam R.Salvage versus primary liver transplantation for early hepatocellular carcinoma: do both strategies yield similar outcomes?.Ann Surg2016;264:155-63

[3] Asham EH,Ghobrial RM.Liver transplantation for hepatocellular carcinoma: past, present, and future..Clin Transpl2012;173-83

[4] Yao FY,LaBerge JM,Brown RJr,Venook A,Emond JC.The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma..Am J Transplant2005;5:795-804

[5] Vitale A,Pastorelli D,Farinati F,Angeli P.Use of sorafenib in patients with hepatocellular carcinoma before liver transplantation: a cost-benefit analysis while awaiting data on sorafenib safety..Hepatology2010;51:165-73

[6] Lee DS.Radiotherapeutics options for hepatocellular carcinoma with portal vein tumor thrombosis..Liver Cancer2014;3:18-30 PMCID:PMC3995383