Complete Remission of Lung Metastases in Hepatocellular Carcinoma Treated with Thalidomide

Abstract

Introduction: Advanced-stage hepatocellular carcinoma (HCC) has poor prognosis mainly because of the underlying liver disease and lack of effective therapeutic options. Pulmonary metastases is the most common site of extra-hepatic spread. Methods: We report the case of complete response with thalidomide for multiple pulmonary metastases from HCC. Results: A 63-year old female, who was a carrier of hepatitis C virus, was preoperatively diagnosed with double primary malignancies of the liver and ampulla. Pancreaticoduodenectomy with synchronous liver resection was performed. Pathology revealed a 4cm moderately differentiated HCC classified as stage IIIB (pT3bN0) with LHV tumor thrombus and a 1cm moderately differentiated adenocarcinoma at the papilla of vater classified as stage IA (pT1N0). Four months later, AFP levels elevated markedly and chest radiograph demonstrated multiple variable sized nodules in both lungs. She was started on sorafenib. However, a tenfold increase in AFP levels and progressive disease on chest radiograph were found after 6 weeks. We changed the regimen to thalidomide at a daily dose of 100mg. Within a month, AFP levels declined rapidly and the number and size of the metastatic lung nodules decreased. After two months, chest radiograph showed complete response of the lung metastases. The patient has received thalidomide for the past three years, and no signs of recurrence of lung metastases have been observed. Conclusions: The role of systemic chemotherapy for metastatic HCC has not yet been clarified. Our findings suggest that treatment with thalidomide may be a promising method for patients with metastatic lung cancer from HCC.