Exceptional serological and radiological response to sorafenib in 2 patients with advanced hepatocellular carcinoma and chronic hepatitis C viral infection: case report and review of the literature

Abstract

Background: In patients with advanced hepatocellular carcinoma (HCC), the multikinase inhibitor sorafenib is the only systemic treatment that has been shown to increase overall survival. However, similar to other tyrosine kinase inhibitors, most patients achieve disease stabilisation radiologically, and only 2-3% of patients achieve a partial response. Recent exploratory subgroup analyses of the large phase 3 trials have demonstrated that patients with chronic hepatitis C virus (HCV) infection associated HCC survive longer than those who are negative for HCV. The mechanism underlying this currently remains unknown. A small number of cases of complete response to sorafenib treatment have now been reported worldwide, however a prolonged response has only been reported in 2 cases, both of whom had HCV-related HCC.

Case presentation: A 55 year old gentleman was diagnosed with hepatocellular carcinoma and concomitant chronic hepatitis C viral infection. He progressed following transarterial chemoemoblisation treatment and was commenced on sorafenib treatment. His serum alphafetoprotein level normalised within 2 months of treatment and he achieved an almost complete radiological response. This response was maintained for 20 months before the patient progressed. A 75 year old lady was diagnosed with advanced hepatocellular carcinoma and concomitant chronic hepatitis C viral infection. She was commenced on sorafenib treatment but required early dose reductions due to palmar plantar erythrodysesthesia, and liver decompensation. Despite this she achieved an excellent serological and radiological response that was maintained for 24 months.

Conclusions: Our two cases show that patients with HCV-associated HCC can attain excellent responses to sorafenib treatment that is durable. Furthermore, such exceptional responses can be achieved even with dose reductions and treatment breaks.

Keywords: Hepatitis C virus infection; Hepatocellular carcinoma; Sorafenib.

Fig. 1

Case 1 response to sorafenib. a. Triple phase CT of the liver 07/12/2012. Primary HCC with arterial phase enhancement (# top panel) and portal venous washout (§ middle panel) with involved lymph node between portal vein and IVC (bottom panel *). b. Triple phase CT of the liver 03/04/2013. Primary HCC with reduced arterial phase enhancement (# top panel) and portal venous washout (§ middle panel) with two cystic areas. Reduction in size of lymph node (bottom panel *). c. Triple phase CT of the liver 15/07/2013. No arterial phase enhancement (top panel) or portal phase washout (middle panel) reflecting disappearance of tumour. Residual cystic areas. Sustained reduction in size of lymph node (bottom panel *)

Fig. 2

Case 2 response to sorafenib. a. Triple phase CT of the liver 10/06/2013. Primary HCC with arterial phase enhancement (top panel) and portal venous washout (bottom panel). b. Triple phase CT of the liver 19/12/2014. Primary HCC with no arterial phase enhancement (top panel) or portal venous washout (bottom panel)