Abbadessa G, Rimassa L, Pressiani T, Carrillo-Infante C, Cucchi E, Santoro A. Optimized management of advanced hepatocellular carcinoma: Four long-lasting responses to sorafenib. World J Gastroenterol 2011; 17(19): 2450-2453 [PMID: 21633647 DOI: 10.3748/wjg.v17.i19.2450]
Corresponding Author of This Article
Lorenza Rimassa, MD, Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy. lorenza.rimassa@humanitas.it
Article-Type of This Article
Case Report
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Giovanni Abbadessa, Lorenza Rimassa, Tiziana Pressiani, Armando Santoro, Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, 20089 Rozzano, Milan, Italy
Giovanni Abbadessa, Department of Human Pathology and Oncology, Program of Genetic Oncology, University of Siena, 53100 Siena, Italy
Cynthia Carrillo-Infante, Department of Human Pathology and Oncology, Program of Molecular Pathology, University of Siena, 53100 Siena, Italy
Emanuele Cucchi, Department of Radiology and Ultrasound, Polidiagnostico CAM, 20052 Monza, Italy
Author contributions: Abbadessa G and Rimassa L designed the paper, performed the acquisition, analysis and interpretation of data, wrote the article and gave final approval; Pressiani T performed the acquisition, analysis and interpretation of data, critically revised the article and gave final approval; Carrillo- Infante C contributed to conception and design of the paper and interpretation of data, wrote the article, and gave final approval; Cucchi E contributed to acquisition, analysis and interpretation of data, critically revised the article, and gave final approval; Santoro A contributed to analysis and interpretation of data, critically revised the article and gave final approval.
Correspondence to: Lorenza Rimassa, MD, Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy. lorenza.rimassa@humanitas.it
Telephone: +39-2-82244573 Fax: +39-2-82244590
Received: September 2, 2010 Revised: February 15, 2011 Accepted: February 22, 2011 Published online: May 21, 2011
Abstract
The therapeutic options for hepatocellular carcinoma (HCC) have been so far rather inadequate. Sorafenib has shown an overall survival benefit and has become the new standard of care for advanced HCC. Nevertheless, in clinical practice, some patients are discontinuing this drug because of side effects, and misinterpretation of radiographic response may contribute to this. We highlight the importance of prolonged sorafenib administration, even at reduced dose, and of qualitative and careful radiographic evaluation. We observed two partial and two complete responses, one histologically confirmed, with progression-free survival ranging from 12 to 62 mo. Three of the responses were achieved following substantial dose reductions, and a gradual change in lesion density preceded or paralleled tumor shrinkage, as seen by computed tomography. This report supports the feasibility of dose adjustments to allow prolonged administration of sorafenib, and highlights the need for new imaging criteria for a more appropriate characterization of response in HCC.
