Sorafenib treatment in recurrent hepatocellular carcinoma post liver transplantation.

Abstract

e15613 Background: Liver transplantation (LT) is a potentially curative treatment for patients (pts) with selective hepatocellular carcinoma (HCC). HCC recurrence post LT is estimated to be 15-20%. Data on systemic therapy post-recurrence is scarce and limited case series suggest that sorafenib (SOR) may have benefit in this population. We reviewed a single center experience with SOR in recurrent HCC post LT Methods: A retrospective review was conducted on pts with recurrent HCC post LT at University Health Network (UHN) who were treated with SOR. Pt characteristics were collected including age, gender, comorbidities, background liver disease, type of LT, and time to recurrence after LT. Treatment information collected included: initial SOR dose (and adjustments), adverse events (AEs), duration of treatment and survival. Results: Between 2006 and 2016, 24 pts were identified. The average age was 60 years (range: 18-72), most pts were male (20/4), living/cadaveric transplant: 11/13. HCC etiology included hepatitis B (10), alcohol (4), NASH (3), hepatitis C (2), hemochromatosis (2), Budd-Chiari (2) and unknown (1). The average time to recurrence of HCC was 16.08 (range: 1.5-60) months post OLT. There was a bimodal time to recurrence with a median of 6 months. SOR starting doses were 200 mg BID in 18 pts, 300 mg BID in 1 and 400 mg BID in 4. 14 pts required dose adjustment due to AEs, mainly relating to fatigue and palmar-plantar syndrome. The median time on treatment was 2.5 (range: 0.25-37) months. The average time to progression on SOR and/or discontinuation due to AEs was 4.30 (+/- 7.2) months. Conclusions: SOR is reasonably tolerated in pts with recurrent HCC post LT, with expected AE profiles. In this small case series, the median time on SOR was short and estimated time to progression was shorter than that in non-transplant HCC population. Overall, SOR has limited activity in this population, but selected pts may derive extended benefit. Better understanding of responders and investigations of other therapies are needed for this population.