Abstract
Sorafenib is the only validated pharmacological treatment option for patients with advanced hepatocellular carcinoma (HCC) in the context of Child-Pugh class A liver function. Effective and safe systemic treatments for advanced disease with severe underlying cirrhosis (Child-Pugh class B and C) are not yet available. A few reports have described capecitabine as an option after failure of sorafenib or for patients who were not eligible for clinical trials. Here, we present a case of good response to low dose capecitabine in a patient with advanced HCC.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third most frequent cause of cancer-related death worldwide [1]
An oral multikinase inhibitor, is the only systemic agent proven to be effective in patients with HCC and Child-Pugh A liver function
We describe a patient with advanced HCC who obtained longlasting objective response with low-dose capecitabine monotherapy; we may suggest this capecitabine schedule to optimize the treatment of HCC when sorafenib fails or is not indicated
Summary
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third most frequent cause of cancer-related death worldwide [1]. An oral multikinase inhibitor, is the only systemic agent proven to be effective in patients with HCC and Child-Pugh A liver function. Two randomized phase-III studies demonstrated a mean survival advantage of approximately 3 months [3,4] with sorafenib as compared to placebo, establishing sorafenib as the reference standard systemic treatment for patients with advanced HCC who still have preserved liver function. The patient was referred to our oncologic unit to evaluate possible systemic approaches At first evaluation, his clinical condition and blood test classified the patient with Child-Pugh B7 liver function. Since the patient was still classified as Child-Pugh class B (platelets 89 x10.9/L; total bilirubin 28,6 μmol/L; albumine 38 g/L; PT 78, INR 1,07), abnormal ascites and Barcellona Clinic Liver Cancer (BCLC) B. Progression free survival is 50 months (Figure 7-9)
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