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Serial changes of clinical parameters in a patient with advanced hepatocellular carcinoma with portal vein thrombosis achieving complete response after treatment with sorafenib.

Kee KM, Hung CH, Wang JH, Lu SN - Onco Targets Ther (2014)

Bottom Line: Sorafenib was initiated at 800 mg/day but was eventually reduced to 400 mg every other day because of a grade 3 hand-foot skin reaction.The alpha fetoprotein (AFP) level decreased rapidly with a linear trend after treatment.There was no more tumor arterial enhancement, and tumor size was decreased to 3.7 cm on day 42.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan ; Chang Gung University College of Medicine, Kaohsiung, Taiwan.

ABSTRACT
The prognosis is usually poor in advanced hepatocellular carcinoma (HCC). Sorafenib is approved for Child-Pugh class A patients with unresectable and advanced HCC. We report here a rare case of a patient with advanced HCC with right portal vein thrombosis (PVT) who achieved a complete response after treatment with sorafenib. This 74-year-old man was a case of non-hepatitis B and C virus-related cirrhosis. Multiphase liver computed tomography showed an 8 cm tumor with early enhance, early wash out, and right PVT at segment 8 of the right lobe. A liver tumor biopsy confirmed the diagnosis of poorly differentiated HCC. Blood tests showed Child-Pugh class A cirrhosis and an alpha-fetoprotein level of 33,058 ng/mL. Sorafenib was initiated at 800 mg/day but was eventually reduced to 400 mg every other day because of a grade 3 hand-foot skin reaction. The alpha fetoprotein (AFP) level decreased rapidly with a linear trend after treatment. After log transformation, the calculated half-life of AFP was 6.84 days. There was no more tumor arterial enhancement, and tumor size was decreased to 3.7 cm on day 42. PVT shrank gradually and localized to the right anterior branch at month 9. There was no recurrence of tumor at the end of follow-up in month 19. Typical serial changes of clinical parameters were demonstrated in this patient.

No MeSH data available.


Related in: MedlinePlus

Serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor, and PVT. Notes: (A) Shows serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor and PVT. The AFP level declined rapidly over time, followed by absence of tumor arterial enhancement, decrease tumor size, and PVT regression; (B) images 1-6 shows serial changes of liver tumor in CT before treatment (8cm, arrow), on day 42 (3.7cm), day 65 (2.9cm), month 6 (2.8cm) and the end of follow-up at month 19 (2.3cm); (C) shows serial changes of right PVT regression, and gradual shrinkage to the right anterior portal branch from images 1 to 6 (arrow). + no significant change of right PVT, - right PVT regression, localized to right anterior branch.Abbreviations: AFP, alpha-fetoprotein; PVT, portal vein thrombosis; QOD, every other day; CT, computed tomography.
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f3-ott-7-829: Serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor, and PVT. Notes: (A) Shows serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor and PVT. The AFP level declined rapidly over time, followed by absence of tumor arterial enhancement, decrease tumor size, and PVT regression; (B) images 1-6 shows serial changes of liver tumor in CT before treatment (8cm, arrow), on day 42 (3.7cm), day 65 (2.9cm), month 6 (2.8cm) and the end of follow-up at month 19 (2.3cm); (C) shows serial changes of right PVT regression, and gradual shrinkage to the right anterior portal branch from images 1 to 6 (arrow). + no significant change of right PVT, - right PVT regression, localized to right anterior branch.Abbreviations: AFP, alpha-fetoprotein; PVT, portal vein thrombosis; QOD, every other day; CT, computed tomography.

Mentions: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. This 74-year-old male patient had non-hepatitis B and C virus (HBV and HCV)-related liver cirrhosis. He was referred from a local hospital, where a liver tumor was detected. Serum HBsAg (the surface antigen of the HBV), anti-HBs Ab (anti-HBV surface antibody), and anti-HCV antibody markers were all negative. Multiphase liver computed tomography (CT) showed an 8 cm liver tumor with early enhance, early wash out, and right PVT at segment 8 of the right lobe (Figure 1). Liver tumor biopsy confirmed the diagnosis of poorly differentiated HCC with a trabecular pattern (Figure 2). Blood tests showed that liver function was classified as Child-Pugh A, and an alpha-fetoprotein (AFP) level was 33,058 ng/mL. Sorafenib therapy was started at the standard dose of 800 mg/day on June 8, 2012 (Figure 3). A grade 3 hand-foot skin reaction happened at 11 days after the initiation of sorafenib treatment, and the dose was then decreased to 400 mg/day. Because of intermittent grade 2 hand-foot skin reaction, the dose was further reduced to 400 mg every other day on day 87.


Serial changes of clinical parameters in a patient with advanced hepatocellular carcinoma with portal vein thrombosis achieving complete response after treatment with sorafenib.

Kee KM, Hung CH, Wang JH, Lu SN - Onco Targets Ther (2014)

Serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor, and PVT. Notes: (A) Shows serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor and PVT. The AFP level declined rapidly over time, followed by absence of tumor arterial enhancement, decrease tumor size, and PVT regression; (B) images 1-6 shows serial changes of liver tumor in CT before treatment (8cm, arrow), on day 42 (3.7cm), day 65 (2.9cm), month 6 (2.8cm) and the end of follow-up at month 19 (2.3cm); (C) shows serial changes of right PVT regression, and gradual shrinkage to the right anterior portal branch from images 1 to 6 (arrow). + no significant change of right PVT, - right PVT regression, localized to right anterior branch.Abbreviations: AFP, alpha-fetoprotein; PVT, portal vein thrombosis; QOD, every other day; CT, computed tomography.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043808&req=5

f3-ott-7-829: Serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor, and PVT. Notes: (A) Shows serial changes of observable parameters in this patient with an effective treatment of sorafenib: AFP level, tumor size, arterial enhancement of tumor and PVT. The AFP level declined rapidly over time, followed by absence of tumor arterial enhancement, decrease tumor size, and PVT regression; (B) images 1-6 shows serial changes of liver tumor in CT before treatment (8cm, arrow), on day 42 (3.7cm), day 65 (2.9cm), month 6 (2.8cm) and the end of follow-up at month 19 (2.3cm); (C) shows serial changes of right PVT regression, and gradual shrinkage to the right anterior portal branch from images 1 to 6 (arrow). + no significant change of right PVT, - right PVT regression, localized to right anterior branch.Abbreviations: AFP, alpha-fetoprotein; PVT, portal vein thrombosis; QOD, every other day; CT, computed tomography.
Mentions: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. This 74-year-old male patient had non-hepatitis B and C virus (HBV and HCV)-related liver cirrhosis. He was referred from a local hospital, where a liver tumor was detected. Serum HBsAg (the surface antigen of the HBV), anti-HBs Ab (anti-HBV surface antibody), and anti-HCV antibody markers were all negative. Multiphase liver computed tomography (CT) showed an 8 cm liver tumor with early enhance, early wash out, and right PVT at segment 8 of the right lobe (Figure 1). Liver tumor biopsy confirmed the diagnosis of poorly differentiated HCC with a trabecular pattern (Figure 2). Blood tests showed that liver function was classified as Child-Pugh A, and an alpha-fetoprotein (AFP) level was 33,058 ng/mL. Sorafenib therapy was started at the standard dose of 800 mg/day on June 8, 2012 (Figure 3). A grade 3 hand-foot skin reaction happened at 11 days after the initiation of sorafenib treatment, and the dose was then decreased to 400 mg/day. Because of intermittent grade 2 hand-foot skin reaction, the dose was further reduced to 400 mg every other day on day 87.

Bottom Line: Sorafenib was initiated at 800 mg/day but was eventually reduced to 400 mg every other day because of a grade 3 hand-foot skin reaction.The alpha fetoprotein (AFP) level decreased rapidly with a linear trend after treatment.There was no more tumor arterial enhancement, and tumor size was decreased to 3.7 cm on day 42.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan ; Chang Gung University College of Medicine, Kaohsiung, Taiwan.

ABSTRACT
The prognosis is usually poor in advanced hepatocellular carcinoma (HCC). Sorafenib is approved for Child-Pugh class A patients with unresectable and advanced HCC. We report here a rare case of a patient with advanced HCC with right portal vein thrombosis (PVT) who achieved a complete response after treatment with sorafenib. This 74-year-old man was a case of non-hepatitis B and C virus-related cirrhosis. Multiphase liver computed tomography showed an 8 cm tumor with early enhance, early wash out, and right PVT at segment 8 of the right lobe. A liver tumor biopsy confirmed the diagnosis of poorly differentiated HCC. Blood tests showed Child-Pugh class A cirrhosis and an alpha-fetoprotein level of 33,058 ng/mL. Sorafenib was initiated at 800 mg/day but was eventually reduced to 400 mg every other day because of a grade 3 hand-foot skin reaction. The alpha fetoprotein (AFP) level decreased rapidly with a linear trend after treatment. After log transformation, the calculated half-life of AFP was 6.84 days. There was no more tumor arterial enhancement, and tumor size was decreased to 3.7 cm on day 42. PVT shrank gradually and localized to the right anterior branch at month 9. There was no recurrence of tumor at the end of follow-up in month 19. Typical serial changes of clinical parameters were demonstrated in this patient.

No MeSH data available.


Related in: MedlinePlus