Complete clinical response of a patient with lymph node and pulmonary metastatic hepatocellular carcinoma to very low-dose sorafenib (Nexavar®) therapy

Abstract

We present the case of a patient with metastatic hepatocellular carcinoma (HCC) who showed complete response (CR) to very low-dose sorafenib therapy. The patient was a 74-year-old woman who had previously undergone S7/8 hepatectomy for HCC in December 2002. Intrahepatic recurrence developed in August 2007, and transcatheter arterial chemoembolization was performed seven times. An increase in the level of the tumor marker alpha-fetoprotein (AFP) was observed, and thus positron emission tomography-computed tomography (PET-CT) was performed in June 2010. PET-CT showed an accumulation of metastatic cells resulted in a swollen periaortic lymph node. Based on the features of this lymph node metastasis, HCC was diagnosed. Oral sorafenib (Nexavar®) was started at an initial dose of 400 mg/day given three times a week. Sorafenib therapy was discontinued when adverse reactions such as bloody sputum and hand tremor were noted after 1 week of therapy. Following improvement of the adverse reactions, sorafenib therapy was resumed at 200 mg/day given three times a week. Two months after the reinitiation of sorafenib therapy, CT showed no change in the lymph node metastasis, and previously undetected pulmonary metastasis was diagnosed. At 5 months of therapy, CT showed no pulmonary and lymph node metastases. As the patient developed another adverse effect of sorafenib therapy, the frequency of sorafenib administration was reduced to two times a week at 200 mg/day. After 15 months of sorafenib therapy at 200 mg/day given two times a week, the patient showed CR and remains in CR at this writing.