Infectious Disease Unit, bRadiology Unit, and cMedical Oncology Unit, C Poma Hospital, Mantova, Italy.
Oncologist. 2010;15(2):142-5. doi: 10.1634/theoncologist.2010-0010. Epub 2010 Feb 8.
BACKGROUND/AIMS: HIV and hepatitis C virus (HCV) share common modes of transmission, resulting in about 33% incidence of coinfection among people infected with HIV. The survival benefit from highly effective antiretroviral therapy (HAART) for HIV infection is resulting in an increased incidence of hepatocellular carcinoma (HCC) in this population. There are no reports to date regarding the coadministration of HAART and sorafenib for hepatocellular carcinoma.
We report the case of a 42-year-old male patient coinfected with HIV and HCV who developed advanced HCC not amenable to curative therapy. The patient was treated with sorafenib, an oral multikinase inhibitor shown to lead to a longer median survival time and time to progression in patients with advanced HCC. Antiretroviral therapy was continued during sorafenib therapy.
The patient achieved a partial tumor response after 3 months and continued to respond at subsequent assessments. His serum alpha-fetoprotein normalized from 2,172 IU/ml to 2 IU/ml. He had durable stable disease after 23 months of therapy. Antiretroviral therapy was efficacious (CD4(+) lymphocyte count, 377/microl; HIV viremia, <50 copies/ml). The simultaneous administration of these therapies was well tolerated. No grade 3 or 4 toxicities were observed. Exacerbation of pre-existing hypertension, grade 2 diarrhea, and grade 1 skin reaction were observed.
This is the first report in which sorafenib has been successfully used to treat HCC in a patient with HIV-HCV coinfection.
背景/目的：HIV 和丙型肝炎病毒（HCV）具有共同的传播途径，导致约 33%的 HIV 感染者合并感染。高效抗逆转录病毒疗法（HAART）治疗 HIV 感染的生存获益导致该人群中肝细胞癌（HCC）的发病率增加。目前尚无关于 HAART 和索拉非尼联合治疗 HCC 的报告。
我们报告了一例 42 岁男性 HIV 和 HCV 合并感染患者，患有无法治愈的晚期 HCC。该患者接受了索拉非尼治疗，这是一种口服多激酶抑制剂，可延长晚期 HCC 患者的中位总生存期和无进展生存期。在索拉非尼治疗期间继续进行抗病毒治疗。
患者在 3 个月后获得部分肿瘤反应，并在随后的评估中继续有反应。他的血清甲胎蛋白从 2172 IU/ml 降至 2 IU/ml。在 23 个月的治疗后，他的病情稳定。抗病毒治疗有效（CD4+淋巴细胞计数为 377/μl；HIV 病毒载量<50 拷贝/ml）。同时给予这些治疗方法耐受良好。未观察到 3 级或 4 级毒性。观察到原有高血压加重，2 级腹泻和 1 级皮肤反应。
这是首例成功应用索拉非尼治疗 HIV-HCV 合并感染患者 HCC 的报告。
