Vascular Endothelial Growth Factor as a Marker of Response to Sorafenib Treatment in Patients with Hepatocellular Carcinoma

Abstract

Abstract Background Liver cancer remains a global health challenge and its incidence is growing worldwide. It is estimated that by year 2025, more than one million individuals will be affected by liver cancer annually. Hepatocellular carcinoma (HCC) is the most common form of liver cancer and accounts for 90% of cases. Hepatitis B virus (HBV) infection is the most prominent risk factor for HCC development, accounting for 40% of cases and Hepatitis C virus (HCV) infection is the leading cause of HCC in Egypt by 84%. Aim of the Work The present study aimed to evaluate the level of VEGF before and after 3 months of treatment with Sorafenib, and evaluate the efficacy of VEGF as a prognostic marker by Correlating it’s level with the radiological response after 3 months of Sorafenib. Patients and Methods This was a prospective cohort study that was carried out in The Hepatocellular carcinoma outpatient clinic and Tropical Medicine department, at Ain Shams University Hospitals. A total of 30 patients were enrolled, including 23 males and 7 females, with a mean age 62 years (51-76 years). all the included patients were CHILD A or B score 7 with performance status zero or 1 during the interval between June 2022 and June 2023. Results Thirty patients were included in the current study, twenty-sex of them were with BCLC-C and 4 patients were with BCLC-B with multiple untreatable sessions of TACE. The etiology of HCC in 28 patients was due to HCV infection while the etiology of 2 patients was due to HBV infection. Before treatment there were 17 patients of the included patients with CHILD A score 5, six patients were with CHILD A score 6 and 7 patients were with CHILD B score 7. After 3 months of Sorafenib, there was deterioration of liver function as 9 patients of the included patients were with CHILD A score 5, ten patients were with CHILD A score 6, seven patients were with CHILD B score 7 and 4 patients were with CHILD B score 8. Nine of the included patients achieved disease control (DC) in the form of either partial response (PR) {4 patients} or stationary disease (SD) {5 patients}. The level of VEGF before Sorafenib couldn’t predict the clinical and the radiological outcomes of the included patients. While, the post-treatment VEGF level showed a significant relation with the radiological assessment (mRECIST) 3 months after treatment as the highest level of VEGF was in patients with progressive disease (PD) and the lowest value in partial response (PR). Conclusion This study characterizes the pattern of VEGF levels before and 3 months after treatment of Sorafenib in post-hepatitis HCC cirrhotic patients. The pre-therapeutic serum VEGF levels in HCC patients couldn’t predict the clinical and the radiological outcomes of the included patients but the post-treatment level showed a significant correlation with a HCC progression according to mRECIST criteria.