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Letters to the Editor
Hepatocellular carcinoma treatment with Sorafenib: A remarkable case of eight-years remission without significant toxicity
Ana L. Santosa,b,
Corresponding author
anaasantos89@gmail.com

Corresponding author at:
, Hélder Cardosoa,b, Marco Silvaa,b, Adriana Moreirac, Guilherme Macedoa,b
a Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
b Faculty of Medicine, Porto University, Portugal
c Radiology Department, Centro Hospitalar de São João, Porto, Portugal
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small esophageal varices&#44; without red signs were observed&#46; It was performed a magnetic resonance that demonstrated multiple confluent nodular images in the hepatic right lobe&#44; appearing a nodulariform area with 106<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>82<span class="elsevierStyleHsp" style=""></span>mm&#44; with typical findings of multifocal hepatocellular carcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The main portal vein was patent&#44; although its left branch was involved by lesion&#44; and there was no evidence of metastases in staging&#46; As HCC was in BCLC stage-B &#40;intermediate&#41;&#44; he was proposed for transarterial chemoembolization that was unfeasible due to a high-flow hepatic arteriovenous fistula&#46; In the context of stage migration&#44; he started on sorafenib that was tolerated at full-dose &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#44; bid&#41;&#44; simultaneously with prophylaxis for palmoplantar syndrome&#46; Despite&#44; a mild palmar erythema&#44; or other adverse effects were observed neither a dose reduction was required&#46; Thus&#44; sorafenib therapy was maintained at the same dose&#44; without interruptions&#44; during these eight years&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical course was favorable&#44; with a progressive reduction in the number&#44; size and degree of contrast uptake&#44; achieving partial response criteria of <span class="elsevierStyleItalic">Response Evaluation Criteria In Solid Tumors</span> &#40;RECIST&#41; and modified RECIST&#46; The alfa-fetoprotein levels normalized after 18 months of treatment and this response has been persistent in the past 8 years&#44; since the start of therapy &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Analytically&#44; a reduction of transaminases was observed with normalization of AP&#46; In 2015&#44; he achieved HCV &#40;genotype 3&#41; cure after 24 weeks antiviral therapy with sofosbuvir&#44; ledipasvir and ribavirin&#46; Nowadays&#44; the patient is assymptomatic and with a good quality of life &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">International guidelines recommend that sorafenib should be maintained until clinical or radiographic progression&#46; However&#44; the best method to evaluate its therapeutic response is still unclear&#59; a relevant concern is that the antiangiogenic effect may overestimate the response in conventional imagiologic methods &#40;mRECIST&#41; <a class="elsevierStyleCrossRef" href="#bib0030">&#91;1&#93;</a>&#46; This is most important when assessing a possible downstaging&#44; which would enable other therapies&#44; such as liver transplantation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the literature&#44; there are some cases described of complete remission of HCC after sorafenib therapy <a class="elsevierStyleCrossRef" href="#bib0035">&#91;2&#93;</a>&#59; however&#44; this case is&#44; at best of our knowledge&#44; the one who presents the greater follow-up time after the achievement of remission&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Despite several studies&#44; it has not been possible to identify which patients are the best candidates for this systemic therapy&#44; with a higher probability of complete response&#46; Nevertheless&#44; the occurrence of adverse events has been associated with improved survival&#47;outcome of HCC treated with sorafenib <a class="elsevierStyleCrossRefs" href="#bib0040">&#91;3&#44;4&#93;</a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this patient&#44; although liver function remained stable and without worsening of portal hypertension&#44; a potential indication for liver resection or transplantation is debatable&#44; namely concerning the imagiological downstaging&#44; as discussed above&#44; and the risk-benefit of this invasive intervention when the patient is asymptomatic with a long-term oral therapy&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nothing to declare&#46; The data have been generated as part of the routine work of an organization&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nothing to declare&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos