Multimodal and systemic therapy with cabozantinib for treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report with long term follow-up outcomes.
Abdominal Pain
/ etiology
Adult
Anilides
/ administration & dosage
Carcinoma, Hepatocellular
/ diagnosis
Combined Modality Therapy
Diagnosis, Differential
Female
Follow-Up Studies
Humans
Liver Neoplasms
/ diagnosis
Liver Transplantation
Molecular Targeted Therapy
Neoplasm Metastasis
Neoplasm Recurrence, Local
Postoperative Complications
/ diagnosis
Pyridines
/ administration & dosage
Radiofrequency Ablation
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
24 Sep 2021
24 Sep 2021
Historique:
received:
22
06
2021
accepted:
12
08
2021
entrez:
24
9
2021
pubmed:
25
9
2021
medline:
2
10
2021
Statut:
ppublish
Résumé
Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains a major therapeutic challenge. In recent years, new molecular-targeted therapies, such as cabozantinib, have been approved for the treatment of advanced HCC. However, clinical experience with these new drugs in the treatment of HCC in the LT setting is very limited. In 2003, a 36-year-old woman was referred to the hospital with right upper abdominal pain. An initial ultrasound of the liver demonstrated a large unclear lesion of the left lobe of the liver. The magnet resonance imaging findings confirmed a multifocal inoperable HCC in a non-cirrhotic liver. Seven years after receiving a living donor LT, pulmonary and intra-hepatic recurrence of the HCC was radiologically diagnosed and histologically confirmed. Following an interdisciplinary therapy concept consisting of surgical, interventional-radiological (with radiofrequency ablation [RFA]) as well as systemic treatment, the patient achieved a survival of more than 10 years after tumor recurrence. As systemic first line therapy with sorafenib was accompanied by grade 3 to 4 toxicities, such as mucositis, hand-foot skin reaction, diarrhea, liver dysfunction, and hyperthyroidism, it had to be discontinued. After switching to cabozantinib from June 2018 to April 2020, partial remission of all tumor manifestations was achieved. The treatment of the remaining liver metastasis could be completed by RFA. The therapy with cabozantinib was well tolerated, only mild arterial hypertension and grade 1 to 2 mucositis were observed. Liver transplant function was stable during the therapy, no drug interaction with immunosuppressive drugs was observed. More than 10 years survival after recurrence of HCC after living-donor LT due to intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy with cabozantinib in the second line therapy. In conclusion, this report highlights the tolerability and effectiveness of cabozantinib for the treatment of HCC recurrence after LT. We show that our patient with a late recurrence of HCC after LT benefitted from intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy.
Identifiants
pubmed: 34559100
doi: 10.1097/MD.0000000000027082
pii: 00005792-202109240-00009
pmc: PMC8462617
doi:
Substances chimiques
Anilides
0
Pyridines
0
cabozantinib
1C39JW444G
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e27082Subventions
Organisme : Deutsche Krebshilfe
ID : 109255
Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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