Managing Metastatic Hepatocellular Carcinoma
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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