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Complete Metabolic Response with Recanalization of Portal Vein Tumor Thrombosis after Sunitinib in a Patient with Advanced Hepatocellular Carcinoma.

Basso M, Basso M, Iaculli A, Pompili M, Riccardi L, Barbaro B, Rufini V, Cassano A, Castaldi P, Barone C - Case Rep Oncol (2010)

Bottom Line: Before the introduction of sorafenib (SOR), a tyrosine kinase inhibitor, no effective treatment was available for patients with advanced disease.During the third cycle, our patient experienced a life-threatening hematemesis with hemorrhagic shock that required intensive care treatment and SUN discontinuation.However, he completely recovered, and the PET/CT scan performed 1 year after the adverse effect demonstrated no evidence of the tumor together with portal vein recanalization.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Oncology and, Department of Internal Medicine, Rome, Italy.

ABSTRACT
The prognosis of patients with advanced hepatocellular carcinoma (HCC) is very poor. The outcome of these patients is particularly bleak when the disease is complicated by portal vein tumor thrombosis (PVTT), since the increased portal pressure often causes serious gastrointestinal bleedings. Before the introduction of sorafenib (SOR), a tyrosine kinase inhibitor, no effective treatment was available for patients with advanced disease. SOR is now considered the standard treatment even for patients with tumor thrombosis, although the well-known interference between tyrosine kinase inhibitors and the coagulation pathway calls for caution against their use in this setting. Here, we report the case of a 74-year-old male patient with advanced HCC and PVTT treated with sunitinib (SUN), another multikinase inhibitor. During the third cycle, our patient experienced a life-threatening hematemesis with hemorrhagic shock that required intensive care treatment and SUN discontinuation. However, he completely recovered, and the PET/CT scan performed 1 year after the adverse effect demonstrated no evidence of the tumor together with portal vein recanalization. The short course of SUN causing both tumor response and gastrointestinal bleeding warrants further studies on the effectiveness of SUN in this setting as well as on the duration of treatment with multikinase inhibitors in patients with tumor thrombosis.

No MeSH data available.


Related in: MedlinePlus

PET-CT scan at baseline (a) and 1 year later (b).
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Figure 2: PET-CT scan at baseline (a) and 1 year later (b).

Mentions: A 72-year-old male patient affected by chronic HCV-related hepatitis underwent percutaneous alcohol injection for a nodule of the sixth segment of the liver. Two years later, an abdominal CT scan demonstrated a massive thrombus involving the main portal vein and its branches, with infiltrative (not evaluable according to RECIST) neoplastic pattern of the sixth segment (fig. 1a1–a3). Histologic and cytologic examination of a needle biopsy of the infiltrative lesion and a fine needle aspiration of the portal vein thrombus demonstrated a poorly differentiated trabecular HCC with tumor thrombosis. Child-Pugh score was A6 with MELD score 10, and the tumor stage was BCLC-C. Serum albumin, ammonium, creatinine and coagulation parameters were normal; blood chemistry documented only a slight increase in transaminases (ALT 66 IU/l and AST 57 IU/l), alkaline phosphatase (377 IU/l) and γ-glutamyltransferase (122 IU/l). Blood count showed mild anemia (hemoglobin 11.2 g/dl) and thrombocytopenia (84 × 103/mm3). There was no ascites, and serum a-fetoprotein was 3 ng/ml. No distant metastases were detected on a whole-body CT scan and bone scintigraphy, and upper endoscopy showed no esophageal varices. 18F-Fluorodeoxyglucose (FDG) PET-CT showed 18F-FDG uptake (fig. 2a) in the sixth segment of the right lobe (standard uptake value, SUV, 4.6) and also at the liver hilum (SUV 3.1.).


Complete Metabolic Response with Recanalization of Portal Vein Tumor Thrombosis after Sunitinib in a Patient with Advanced Hepatocellular Carcinoma.

Basso M, Basso M, Iaculli A, Pompili M, Riccardi L, Barbaro B, Rufini V, Cassano A, Castaldi P, Barone C - Case Rep Oncol (2010)

PET-CT scan at baseline (a) and 1 year later (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2992427&req=5

Figure 2: PET-CT scan at baseline (a) and 1 year later (b).
Mentions: A 72-year-old male patient affected by chronic HCV-related hepatitis underwent percutaneous alcohol injection for a nodule of the sixth segment of the liver. Two years later, an abdominal CT scan demonstrated a massive thrombus involving the main portal vein and its branches, with infiltrative (not evaluable according to RECIST) neoplastic pattern of the sixth segment (fig. 1a1–a3). Histologic and cytologic examination of a needle biopsy of the infiltrative lesion and a fine needle aspiration of the portal vein thrombus demonstrated a poorly differentiated trabecular HCC with tumor thrombosis. Child-Pugh score was A6 with MELD score 10, and the tumor stage was BCLC-C. Serum albumin, ammonium, creatinine and coagulation parameters were normal; blood chemistry documented only a slight increase in transaminases (ALT 66 IU/l and AST 57 IU/l), alkaline phosphatase (377 IU/l) and γ-glutamyltransferase (122 IU/l). Blood count showed mild anemia (hemoglobin 11.2 g/dl) and thrombocytopenia (84 × 103/mm3). There was no ascites, and serum a-fetoprotein was 3 ng/ml. No distant metastases were detected on a whole-body CT scan and bone scintigraphy, and upper endoscopy showed no esophageal varices. 18F-Fluorodeoxyglucose (FDG) PET-CT showed 18F-FDG uptake (fig. 2a) in the sixth segment of the right lobe (standard uptake value, SUV, 4.6) and also at the liver hilum (SUV 3.1.).

Bottom Line: Before the introduction of sorafenib (SOR), a tyrosine kinase inhibitor, no effective treatment was available for patients with advanced disease.During the third cycle, our patient experienced a life-threatening hematemesis with hemorrhagic shock that required intensive care treatment and SUN discontinuation.However, he completely recovered, and the PET/CT scan performed 1 year after the adverse effect demonstrated no evidence of the tumor together with portal vein recanalization.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Oncology and, Department of Internal Medicine, Rome, Italy.

ABSTRACT
The prognosis of patients with advanced hepatocellular carcinoma (HCC) is very poor. The outcome of these patients is particularly bleak when the disease is complicated by portal vein tumor thrombosis (PVTT), since the increased portal pressure often causes serious gastrointestinal bleedings. Before the introduction of sorafenib (SOR), a tyrosine kinase inhibitor, no effective treatment was available for patients with advanced disease. SOR is now considered the standard treatment even for patients with tumor thrombosis, although the well-known interference between tyrosine kinase inhibitors and the coagulation pathway calls for caution against their use in this setting. Here, we report the case of a 74-year-old male patient with advanced HCC and PVTT treated with sunitinib (SUN), another multikinase inhibitor. During the third cycle, our patient experienced a life-threatening hematemesis with hemorrhagic shock that required intensive care treatment and SUN discontinuation. However, he completely recovered, and the PET/CT scan performed 1 year after the adverse effect demonstrated no evidence of the tumor together with portal vein recanalization. The short course of SUN causing both tumor response and gastrointestinal bleeding warrants further studies on the effectiveness of SUN in this setting as well as on the duration of treatment with multikinase inhibitors in patients with tumor thrombosis.

No MeSH data available.


Related in: MedlinePlus