scholarly journals Advanced Stage Hepatocellular Carcinoma with Multiple Metastasis and Vascular Thrombosis: A Case of Complete Response to Sorafenib

2016 ◽  
Vol 29 (2) ◽  
pp. 139 ◽  
Author(s):  
Adélia Simão ◽  
Raquel Silva ◽  
Lurdes Correia ◽  
Filipe Caseiro Alves ◽  
Armando Carvalho ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Kinase Inhibitor ◽  
Performance Status ◽  
Evaluation Criteria ◽  
Vena Cava ◽  
Complete Response ◽  
Response To Treatment ◽  
Advanced Hepatocellular Carcinoma ◽  
And Performance ◽  
The Right

Sorafenib is a multi-targeted tyrosine kinase inhibitor, with antiangiogenic and antiproliferative properties, approved for the treatment of advanced hepatocellular carcinoma. It induces a significant increase in the median overall survival, despite a complete response to treatment being rare. We report a clinical case of a 60-year-old male with hepatic cirrhosis, Child-Pugh class A and performance status 0, and advanced hepatocellular carcinoma. The primary tumor measured 17 x 8 cm and had diffuse intrahepatic metastization, extensive lung and left adrenal invasion, as well as thrombosis of inferior vena cava, with projection to the right atrium. This patient showed a rapid and complete response to sorafenib, evaluated by mRECIST (modified Response Evaluation Criteria in Solid Tumors), that remains after three years of treatment.

scholarly journals Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

2021 ◽  
pp. 1-4
Author(s):  
Kabalane Yammine ◽  
◽  
Sarah Khalife ◽  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Treatment Strategies ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
The Right

Tumor thrombus infiltration of hepatocellular carcinoma (HCC) into the inferior vena cava and right atrium is rare and is associated with a poor prognosis due to the critical location of the tumor and the limited efficiency of the available treatment strategies. In this study, we report the case of a patient with advanced HCC and tumor thrombus in the inferior vena cava and right atrium who demonstrated complete response with mass retraction upon Yttrium-90 trans-arterial radioembolization (90Y- TARE) therapy. Throughout the 16 months follow-ups after the radioembolization, the patient was free of any complications, revealing no occurrence of radiation-induced pneumonitis or tumor recurrence.

Phase II Trial of the Combination of Bevacizumab and Erlotinib in Patients Who Have Advanced Hepatocellular Carcinoma

2009 ◽  
Vol 27 (6) ◽  
pp. 843-850 ◽  
Author(s):  
Melanie B. Thomas ◽  
Jeffrey S. Morris ◽  
Romil Chadha ◽  
Michiko Iwasaki ◽  
Harmeet Kaur ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Response Rate ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Evaluation Criteria ◽  
Progression Free Survival ◽  
Advanced Hepatocellular Carcinoma ◽  
Study Objective ◽  
Advanced Hcc

Purpose The study objective was to determine the proportion of patients with hepatocellular carcinoma (HCC) treated with the combination of bevacizumab (B) and erlotinib (E) who were alive and progression free at 16 weeks (16-week progression-free survival [PFS16]) of continuous therapy. Secondary objectives included response rate, median PFS, survival, and toxicity. Patients and Methods Patients who had advanced HCC that was not amenable to surgical or regional therapies, up to one prior systemic treatment; Childs-Pugh score A or B liver function; Eastern Cooperative Oncology Group performance status 0, 1, or 2 received B 10 mg/kg every 14 days and E 150 mg orally daily, continuously, for 28-day cycles. Tumor response was evaluated every 2 cycles by using Response Evaluation Criteria in Solid Tumors Group criteria. A total of 40 patients were treated. Results The primary end point of PFS16 was 62.5%. Ten patients achieved a partial response for a confirmed overall response rate (intent-to-treat) of 25%. The median PFSevent was 39 weeks (95% CI, 26 to 45 weeks; 9.0 months), and the median overall survival was 68 weeks (95% CI, 48 to 78 weeks; 15.65 months). Grades 3 to 4 drug-related toxicity included fatigue (n = 8; 20%), hypertension (n = 6; 15%), diarrhea (n = 4; 10%) elevated transaminases (n = 4; 10%), gastrointestinal hemorrhage (n = 5; 12.5%), wound infection (n = 2; 5%) thrombocytopenia (n = 1; 2.5%), and proteinuria, hyperbilirubinemia, back pain, hyperkalemia, and anorexia (n = 1 each). Conclusion The combination of B + E in patients who had advanced HCC showed significant, clinically meaningful antitumor activity. B + E warrant additional evaluation in randomized controlled trials.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

scholarly journals Hypothyroidism Is a Predictive Factor for Better Clinical Outcomes in Patients with Advanced Hepatocellular Carcinoma Undergoing Lenvatinib Therapy

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3078
Author(s):  
Masako Shomura ◽  
Haruka Okabe ◽  
Emi Sato ◽  
Kota Fukai ◽  
Koichi Shiraishi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Duration ◽  
Hormone Replacement ◽  
Evaluation Criteria ◽  
Complete Response ◽  
Good Prognosis ◽  
Advanced Hepatocellular Carcinoma ◽  
Thyroid Hormone Replacement ◽  
Advanced Hcc ◽  
Therapy Initiation

Patients with advanced hepatocellular carcinoma (HCC) undergoing molecular targeted therapy often experience non-negligible adverse events (AEs). Paradoxically, certain AEs are reportedly associated with a good prognosis. We aimed to identify factors predictive of treatment duration and overall survival (OS) in patients with HCC undergoing lenvatinib therapy. Forty-six consecutive patients with advanced HCC who received lenvatinib therapy from April 2018 to November 2019 were prospectively followed until November 2019. Treatment efficacy was assessed according to the modified Response Evaluation Criteria in Solid Tumors for 2–3 months after therapy initiation. The disease control rate (DCR) was defined as the percentage of patients with a complete response, partial response, or stable disease. The DCR was 65.2%, with a median survival of 10.2 months. Grade 2/3 hypoalbuminemia resulted in shorter treatment duration. Factors predictive of longer OS were a Child-Pugh score of 5 at baseline and the occurrence of Grade 2/3 hypothyroidism. Conversely, Grade 2/3 hypoalbuminemia was associated with a poorer prognosis. An AE of Grade 2/3 hypothyroidism was associated with a better prognosis in patients receiving lenvatinib treatment for advanced HCC. Continuing anticancer therapy with appropriate thyroid hormone replacement may contribute to longer OS.

KEYNOTE-224: Phase II study of pembrolizumab in patients with previously treated advanced hepatocellular carcinoma.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. TPS504-TPS504 ◽  
Author(s):  
Andrew X. Zhu ◽  
Jennifer J. Knox ◽  
Masatoshi Kudo ◽  
Stephen L. Chan ◽  
Richard S. Finn ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Disease Progression ◽  
Kinase Inhibitor ◽  
Performance Status ◽  
Objective Response ◽  
Progression Free Survival ◽  
Locoregional Therapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Ecog Performance Status ◽  
Previously Treated

TPS504 Background: The tyrosine kinase inhibitor sorafenib is the standard of care for first-line hepatocellular carcinoma (HCC). For patients with HCC after disease progression on sorafenib or for those with intolerance to sorafenib, no approved therapies are available. Because HCC is often driven by inflammation and is also associated with a suppressed immunoenvironment, there is a strong rationale to evaluate immunotherapy in patients with this type of cancer. The single-arm, multisite, phase 2 KEYNOTE-224 study (ClinicalTrials.gov, NCT02702414) was designed to evaluate the efficacy and safety of the anti–PD-1 antibody pembrolizumab in patients with previously treated advanced HCC. Methods: Approximately 100 patients will be enrolled. Inclusion criteria include age ≥18 years, histologically or cytologically confirmed diagnosis of HCC Barcelona Clinic Liver Cancer (BCLC) stage C disease or BCLC stage B disease not amenable to or refractory to locoregional therapy, and disease not amenable to a curative treatment approach (eg, transplantation, surgery, or ablation). Patients must also have measurable disease based on RECIST v1.1 as confirmed by central imaging vendor review, documented objective radiographic progression after stopping treatment with sorafenib or intolerance to sorafenib, Child-Pugh liver score A, ECOG performance status 0-1, and predicted life expectancy > 3 months. Patients will be allocated to receive pembrolizumab 200 mg IV every 3 weeks for up to 35 cycles (~2 years) or until disease progression, unacceptable toxicity, patient withdrawal of consent, or investigator decision. Response will be assessed every 9 weeks per RECIST v1.1 by central imaging vendor review. Adverse events (AEs) will be assessed throughout treatment and for 30 days thereafter (90 days for serious AEs) and graded per NCI CTCAE v4.0. The primary end point is objective response rate per RECIST v1.1 by central imaging vendor review. Secondary end points are overall survival; safety and tolerability; and duration of response, disease control rate, time to progression, and progression-free survival per RECIST v1.1 by central imaging vendor review. Enrollment in KEYNOTE-224 is ongoing. Clinical trial information: NCT02702414.

Complete and Sustained Off-Therapy Response to Sorafenib in Advanced Hepatocellular Carcinoma

2016 ◽  
Vol 25 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Marcello Maida ◽  
Fabio Salvatore Macaluso ◽  
Franco Valenza ◽  
Roberto Virdone
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Event ◽  
Performance Status ◽  
Therapy Response ◽  
Complete Response ◽  
Liver Lesion ◽  
Focal Liver Lesion ◽  
Caucasian Woman ◽  
Advanced Hepatocellular Carcinoma ◽  
Dynamic Ct

A 75-year-old Caucasian woman with alcohol-related cirrhosis was admitted to our Unit in October 2012 for the diagnostic evaluation of a focal liver lesion detected by regular surveillance ultrasound. The subsequent dynamic CT and MR led to a diagnosis of infiltrative hepatocellular carcinoma (HCC) of 5 cm in the hepatic segment IV with neoplastic infiltration of the left branch of the portal vein, in absence of extrahepatic metastases. Therapy with sorafenib 400 mg bid was started and the subsequent dynamic CT performed at the 10th month of therapy showed a complete response according to RECIST criteria and mRECIST, while seriated dosages of α-fetoprotein levels showed a progressive reduction up to normalization. After 18 months of therapy, Sorafenib was discontinued due to a grade 3 adverse event. Nonetheless, all subsequent radiological controls, performed over the following two years confirmed a complete off-therapy response despite withdrawal of Sorafenib. After three years the patient is asymptomatic, with a preserved liver function and undetectable solid tumor lesions at dynamic CT.This case represents one of the few examples of complete response to anti-angiogenic drugs and, to our knowledge, the only case of sustained response, even after the discontinuation of Sorafenib, described so far in the literature. Abbreviations: AFP: alpha-fetoprotein; AE: adverse event; BCLC: Barcelona Clinic Liver Cancer; CT: computed tomography; HCC: hepatocellular carcinoma; mRECIST: modified response evaluation criteria in solid tumors; PS: Performance status; RCTs: randomized controlled trials.

scholarly journals Clinically Silent Intracardiac Metastasis with Extremely Poor Prognosis in a Patient with Hepatocellular Carcinoma

2017 ◽  
Vol 11 (2) ◽  
pp. 416-421 ◽  
Author(s):  
Mashal Salehi ◽  
The Yee ◽  
Eric Alatevi ◽  
Yamin Thein
Keyword(s):  
Hepatocellular Carcinoma ◽  
Poor Prognosis ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Cardiac Metastasis ◽  
Advanced Hepatocellular Carcinoma ◽  
Unusual Site ◽  
Cardiac Extension ◽  
Prognostic Importance ◽  
The Right

Intracavitary cardiac extension remains an unusual site of extrahepatic metastasis in patients with hepatocellular carcinoma. While patients can present with signs and symptoms suggestive of right-sided heart failure, it may be totally asymptomatic, which is very rare with only a few cases reported so far. Also, cardiac metastasis is of great prognostic importance as patients with intracardiac metastasis can have an extremely poor prognosis. Here, we present the case of a 52-year-old male patient with advanced hepatocellular carcinoma, with an incidentally found tumor thrombus extending from the inferior vena cava to the right atrium, protruding through the tricuspid valve into the right ventricle, on routine echocardiography. The patient did not have any signs or symptoms of heart involvement and unfortunately died on the 18th day of the hospital stay.

scholarly journals Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yuki Ohya ◽  
Shintaro Hayashida ◽  
Akira Tsuji ◽  
Kunitaka Kuramoto ◽  
Hidekatsu Shibata ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Kinase Inhibitor ◽  
Sharp Decrease ◽  
Hepatic Function ◽  
Advanced Hepatocellular Carcinoma ◽  
Right Hepatectomy ◽  
Advanced Hcc ◽  
Extended Right Hepatectomy ◽  
The Right

Abstract Background Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive. Case presentation A 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year. Conclusion The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.

A phase II study of sunitinib in patients with advanced hepatocellular carcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4637-4637 ◽  
Author(s):  
A. X. Zhu ◽  
D. V. Sahani ◽  
E. di Tomaso ◽  
D. Duda ◽  
V. Sindhwani ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Phase Ii ◽  
Kinase Inhibitor ◽  
Phase Ii Study ◽  
Performance Status ◽  
Advanced Hepatocellular Carcinoma ◽  
Close Monitoring ◽  
Dce Mri ◽  
Angiogenic Markers ◽  
Tumor Permeability

4637 Background: Patients (pts) with advanced hepatocellular carcinoma (HCC) have a poor prognosis. HCC is a highly vascular tumor with increased levels of angiogenic factors including VEGF and VEGFR. Sunitinib is an oral multitargeted receptor tyrosine kinase inhibitor with activity against VEGFR, PDGFR, and c-KIT. We performed a phase II study to evaluate the efficacy and toxicity of sunitinib in advanced HCC. Methods: Eligibility criteria included unresectable or metastatic measurable HCC, 0–1 prior chemotherapy regimens, performance status = 1, CLIP score = 3, and adequate organ functions. Pts were treated with sunitinib at 37.5 mg po qd on a standard 4 weeks on, 2 weeks off regimen (6 weeks/cycle). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed to assess changes in tumor permeability. Plasma angiogenic markers were assayed by multiplex array. The primary endpoint of the study is progression-free survival (PFS). Results: 19 pts have been enrolled since May 2, 2006: median age = 59 (30–77), M/F = 16/3, ECOG 0/1 = 7/12, CLIP 1/2/3=7/7/5. The treatment was generally well tolerated. Grade 3/4 toxicities included neutropenia (n=4, 21%), lymphopenia (n=3, 16%), SGOT/SGPT (n=3, 16%), fatigue (n=2, 11%), rash (n=2, 11%), and thrombocytopenia (n=2, 11%). One pt had a partial response and 8 pts had stable disease of at least 12 weeks; 8 pts currently remain on study. The median number of treatment cycles received per patient was 2 (range 1–6). The mean tumor permeability (Ktrans) following 2 weeks of sunitinib administration in 13 pts decreased from mean baseline value of 3.77 to 1.06 (an average of 52% decrease). Of the 15 pts analyzed, changes in plasma angiogenic markers from baseline to day 15 following sunitinib treatment were observed as follows: sVEGFR1 remained constant in 15 pts; 8/15 had decreased sVEGFR2 levels; 13/15 and 11/15 pts had increased PlGF and VEGF levels respectively; bFGF levels decreased in 9 and increased in 5 patients. Conclusions: Sunitinib administered in the current dose schedule can be safely given with close monitoring in HCC patients. Preliminary evidence of antitumor activity was observed. Changes in angiogenic parameters on DCE-MRI and in blood markers were seen following sunitinib administration. [Table: see text]

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