Page 216 - ebook HCC

PROGRAMME
214 PROGRAMME AND ABSTRACTSAND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 215
214
FEBRUARY 13 - 16, 2014

Poster Board Number C12

SORAFENIB FOR THE TREATMENT OF NOTES
RECURRENT HEPATOCELLULAR CARCINOMA
AFTER LIVER TRANSPLANTATION. TWO CASES
WITH FATAL OUTCOME

Giovanni Perricone , Andrea Mancuso , Claudio A. Zavaglia , Chiara Mazzarelli ,
1
1
1
1
Antonella Foschi , Aldo Airoldi , Luca S. Belli 1
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1
1 Epatologia e Gastroenterologia, A.O. Ospedale Niguarda, Milano, Italy
Corresponding author’s e-mail: giovanniperricone@gmail.com
Introduction: Hepatocellular carcinoma (HCC) recurrence occurs in 8–20% after liver
transplantation (LT). Sorafenib has demonstrated a survival benefit in non –transplanted
cirrhotics with advanced HCC not amenable to surgical/locoregional treatments. However,
efficacy and safety of sorafenib in the post-LT setting has been scarcely studied.
Methodology: We reviewed the outcome of a consecutive cohort of 15 patients (pts)
(12 M and 3 F) treated with sorafenib for recurrent HCC after LT deemed not eligible to
surgical, ablative or loco-regional treatment from October 2008 to July 2013.
Results: The median time to recurrence was 15 months (mo) (range 2–66). The sites
of metastasis were: only liver in 3 pts, liver and extrahepatic in 8, only extra-hepatic in
4. Neoplastic portal thrombosis was observed in 2 pts. Median serum alpha-fetoprotein
levels before sorafenib administration was 62 ng/ml (range 2– 11143). Mean age at
sorafenib start was 56±7 years. Maximum daily tolerated dose was 800 mg in 4 pts, 400 in
10 and 200 in 1. Eleven pts received everolimus. Median treatment duration was 78 days
(range 15–444). No grade 4 reaction was observed. Grade 3 adverse events occurred in
CLINICAL POSTER ABSTRACTS pts were taken everolimus plus sorafenib and had a partial response at CT. One patient CLINICAL POSTER ABSTRACTS
7/15 pts: fatigue (33%), hypophosphatemia (27%), cholestasis (13%), skin rash (13%)
and hand-foot skin reaction (13%). Two pts died probably due to drug toxicity. Both the
died of massive gastrointestinal bleeding from a severe hemorrhagic gastropathy, without
signs of portal hypertension. Another patient was hospitalized for weight loss and severe
diarrhea 4 mo after sorafenib start and died 17 days later. Overall, 2 mo after the start
of treatment, using mRECIST criteria, 2 pts (13%) showed a partial response, 2 (13%)
showed a stable disease and 9 (60%) showed a progressive disease. None of the pts
achieved a complete response. Treatment response could not be assessed in 2 pts. From
the start of the treatment the median survival was 5 mo (range 1–18). From the date of LT,
median survival was 27 mo (range 6–106).
Conclusions: Our data suggests that in pts with recurrent HCC after LT the combination
of sorafenib and everolimus is badly tolerated and can be associated with relevant
treatment-related mortality. Moreover, the treatment benefit is limited.