Journal of Liver Cancer

Case Reports

A Case of Achieving Partial Remission with the Combination of Sorafenib and Nivolumab in a Patient with Hepatocellular Carcinoma Showing Disease Progression after Nivolumab Therapy: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Ki Jeong Jeon, Cheol-Won Choi, Kyung-Su Kim, Wan Jeon; J Liver Cancer. 2019;19(1):74-78. Published online March 31, 2019; DOI: https://doi.org/10.17998/jlc.19.1.74

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Abstract PDF: Sorafenib is a well-known approved systemic therapeutic agent used in patients with advanced hepatocellular carcinoma (HCC). Regorafenib and nivolumab are approved as second-line therapeutic drugs in patients showing disease progression after sorafenib therapy. However, there is no established third- or fourth-line therapy in patients with progression after regorafenib or nivolumab treatment. Recently, the combination of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICPIs) has been attempted as a firstline treatment strategy in advanced HCC patients based on the hypothesis that combination therapy may overcome resistance in ICPI monotherapy. On the basis of this suggestion, we herein describe the case of an HCC patient demonstrating macrovascular invasion, whereby partial remission was achieved via the combination of sorafenib and nivolumab following disease progression after nivolumab therapy. Further studies on the combination of TKIs and ICPIs are necessary to determine ways to manage HCC patients showing disease progression after ICPI therapy.

A Case of Achieving Complete Remission with Combination of Sorafenib and Tegafur in Patients with Hepatocellular Carcinoma with Progression of Disease after Sorafenib Therapy: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Ki Jeong Jeon, Sang Bu Ahn, Jin-Young Park, Cheol-Won Choi, Kwang-Mo Yang; J Liver Cancer. 2017;17(1):88-93. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.88

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Abstract PDF: Sorafenib is the only approved targeted agent as the first line systemic therapy for treatment of advanced hepatocellular carcinoma (HCC). However, the improvement of survival duration under 3 months is far from clinical satisfactory and most patients experience disease progression within 6 months after sorafenib therapy. Unfortunately, second line systemic therapy after treatment failure of sorafenib was not established and there were no clear guidelines for salvage treatment modalities. Recently, studies suggests that combination of sorafenib and single cytotoxic agent can be relatively effective and safe strategy that achieves promising rates of local and systemic control in advanced HCC patients. Based on above suggestions, we herein offer our experience of a case achieved complete remission by combination therapy of sorafenib and tegafur in the patient with progressed disease after sorafenib therapy.

Review Article

Locoregional Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Sang Youn Hwang, Ryoung-Go Kim, Cheol-Won Choi, Sang Bu Ahn; J Liver Cancer. 2016;16(2):69-81. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.69

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Abstract PDF

Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) have a extremely poor prognosis. According to the Barcelona Clinic Liver Cancer guideline, sorafenib is a standard therapy in this situation, but many clinicians still select locoregional therapy (LRT) such as transarterial therapy, external beam radiation therapy (EBRT), even surgical resection (SR) or combination of LRTs because the survival improvement by sorafenib is unsatisfactory. Based on recent meta-analysis and prospective study, transarterial chemoembolization (TACE) and transarterial radioembolization seem to be effective and safe therapeutic option that have comparable outcome to sorafenib. Recently large nationwide studies demonstrated that SR can be a potentially curative treatment in selected patients. Hepatic arterial infusion chemotherapy (HAIC) can be also good option, especially in Child class B patients based on small volume prospective studies. Moreover, multidisciplinary strategies based on the combination of LRTs (SR plus TACE, TACE + EBRT, TACE + Sorafenib, HAIC + EBRT etc.) may improve survival of HCC patients with PVTT. Finally we discuss individualized and tailored treatment strategies for different clinical situations.

Citations

Citations to this article as recorded by

Progress in Non-Surgical Treatment of Primary Hepatocellular Carcinoma with Combined Portal Vein Carcinoma Thrombosis
文豪寇
Advances in Clinical Medicine.2023; 13(07): 11779. CrossRef

Case Reports

A Case of Achieving Complete Remission with Stereotactic Body Radiation Therapy in Patients with Hepatocellular Carcinoma with Macrovascular Invasion after Repeated Transarerial Chemoembolization: Sang Youn Hwang, Seon-Mi Lee, Jong Woo Im, Ki Jeong Jeon, Sang Bu Ahn, Eun Kyeong Ji, Jin-Young Park, Cheol-Won Choi Choi, Gwang-Mo Yang; J Liver Cancer. 2016;16(2):123-128. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.123

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Abstract PDF: Transarterial chemoembolization (TACE) is the worldwide procedure performed for patients with various stage hepatoceullar carcinoma (HCC), but is not yet considered as curative treatment because of relatively high local recurrence rate. Moreover, many clinicians frequently experience treatment failure (incomplete necrosis or stage progression etc.) after repeated TACE, but no clear guidelines have been recommended about salvage treatment modalities for this situation. Recently, studies for combination of radiation therapy and TACE for HCC with TACE refractoriness have been tried and reported better therapeutic efficacy. Based on above suggestions, we herein offer our experience of a patient with macrovascular invasion developed after repeated TACE that achieve complete remission by stereotactic body radiation therapy. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with TACE refractoriness.

A Case of Achieving Partial Remission with Combination of Radiation Therapy and Sorafenib inChild-Pugh Class B Patients with Hepatocellular Carcinoma with Main Portal Vein Invasion and Lymph Node Metastasis: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Joon Suk Kim, Sang Bu Ahn, Eun Kyeong Ji, Hyun-Cheol Kang, Cheol-Won Choi, Gwang-Mo Yang; J Liver Cancer. 2014;14(2):120-126. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.120

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Abstract PDF: Reserved liver function is one of the most important determinants of survivial in advanced hepatocellular carcinoma (HCC). Especially in cirrhotic patient with decompensated liver function, sorafenib for HCC with main portal vein invasion have limited efficacy and survival benefit. Therefore many clinicians or centers still try locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib in this situation. However this multidisciplinary approach may increase treatment related toxicity such as liver failure, etc. Recently, studies for combination of RT and sorafenib for HCC with portal vein invasion have been tried and reported not only better therapeutic efficacy, but also more hepatic toxicity.Based on above suggestions, we herein offer our experience of a patient that although achieved survival gain via partial remission of intrahepatic tumor and main portal vein thrombosis and metastatic lymph node by combination therapy of RT and sorafenib, finally expired due to hepatictoxicity. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage decompenstated cirrhotic patients with HCC with main portal vein invasion. (J Liver Cancer 2014;14:120-126)

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