Liver Transplantation After Neoadjuvant Sorafenib Therapy: Preliminary Experience and Literature Review

Abstract

Objectives: Neoadjuvant therapies before liver transplantation are a common practice in the management of hepatocellular carcinoma, either in the setting of down staging or as a bridge strategy but sorafenib has been little evaluated.

Materials and methods: Between 2011 and 2013, 212 LT were performed and we retrospectively reviewed the data on patients who had previously received sorafenib.

Results: Five patients were included. The daily sorafenib dose was 400 mg for a mean duration of 17 months before liver transplantation, and was found to be safe (1 severe asthenia). Three patients received sorafenib as bridge therapy after achieving stable tumor disease within the Milan criteria through transarterial chemoembolization or hepatectomy. None patient displayed any living hepatocellular carcinoma tissue after histological examination. The two remaining patients were treated with sorafenib for palliative purposes, and became eligible for transplant after down staging. No tumor recurrence was observed during the 27-month mean follow-up, whereas 2 patients died (multiorgan dysfunction and cerebral hemorrhage). Post-liver transplantation morbidity attributable to sorafenib was mild and secondary to scarring issues: biliary stenosis (n = 2) and evisceration (n = 1).

Conclusions: These few case reports suggest the potential interest and feasibility of controlled studies to assess the efficacy and safety of sorafenib in neoadjuvant setting for hepatocellular carcinoma.