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Hepatocellular Carcinoma Case Studies

Case Studies: Managing Metastatic Hepatocellular Carcinoma

In this case-based interview, Richard S. Finn, MD, discusses the case of a 59-year-old male patient who presents with metastatic liver cancer and the therapeutic management of his disease before and after progression.

Managing Metastatic Hepatocellular Carcinoma

February 2017

  • A 59-year-old man with presented with RUQ pain and fatigue.
  • PMH: Cirrhosis, HCV infection
  • SH: lives alone, drinks alcohol daily (~15 drinks/week)
  • ECOG, 0
  • Laboratory findings:
    • AFP: 677 IU/mL
    • Platelets: 144,000 cells/mm3
    • INR, 1.7
    • Bilirubin: 1.8 mg/dL
    • Albumin: 3.9 g/dL
    • Hepatic encephalopathy: none
    • Ascites: mild
  • Child-Pugh A
  • Abdominal CT scan showed a large mass (8.6 cm) involving hepatic segments IV and VIII with portal vein infiltration, diffuse 1.0-cm to 1.5-cm nodules in the right hepatic lobe; 1.5-cm left portal vein thrombosis
  • Surgical consult, unresectable based on tumor size and portal vein invasion
  • Biopsy findings showed grade 3 hepatocellular carcinoma, marked fibrosis  
  • The patient was treated with TACE; dynamic liver computed tomography at 1 month showed a partial response; repeat TACE showed no additional response
  • The patient was started on sorafenib
  • Imaging at 2 and 6 months showed a partial response with marked regression of the hepatic mass and smaller nodules.

February 2018

  • The patient reports feeling fatigue, requiring rest during the day, but continues to work full-time
  • CT of chest, abdomen, and pelvis showed new pulmonary nodules (2.0 cm and 3.1 cm) consistent with metastatic disease
  • ECOG, 1
  • He was started on regorafenib 160 mg daily
  • After 2 weeks on therapy he developed grade 2 hand-foot syndrome which resolved after dose reduction to 120 mg daily
  • After 3 months the patient has stable disease and improvement of symptoms
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