Gastroenterology Department, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
BMC Gastroenterol. 2011 Jan 17;11:4. doi: 10.1186/1471-230X-11-4.
Hepatocellular carcinoma (HCC) is the fifth most common neoplasia in the world. In the past, treatment of advanced HCC with conventional antineoplastic drugs did not result in satisfactory outcomes: recently, in this patient population the oral multikinase inhibitor sorafenib has been able to induce a statistically significant improvement of overall survival. Similarly to other anti-angiogenic drugs employed in other tumour types, also sorafenib seldom induces the dimensional tumour shrinking usually observed with conventional cytotoxic drugs: data gathered from studies carried out with sorafenib and other competitors under development do not report any complete response in HCV-induced HCC.
An 84-year old man with a long-lasting history of chronic HCV hepatitis was referred to our Institution for an ultrasonography investigation of a focal hepatic lesion. To better characterize the liver disease and clearly define the diagnosis of the focal hepatic lesion, the patient was hospitalized in our department. Laboratory and instrumental investigations confirmed the clinical picture of HCV-related liver cirrhosis and identified a hepatic lesion of about 6 cm featuring infiltrating HCC with thrombosis of the portal trunk. Due to the advanced stage of the disease, therapy with sorafenib 400 mg bid was started. Right from one month after the treatment was started, a reduction of alpha-fetoprotein level was observed which, by the third month, turned down within the normal limits. In addition the CT scan showed 50% reduction of the neoplastic lesion along with canalization of the portal trunk. At the sixth month the normalization of the alpha-fetoprotein level at the lower limit of normality was confirmed and the MRI showed complete disappearance of the neoplasia. In addition a reduction of a metallo-proteinase serum level was observed. At the twelfth month a further MRI confirmed complete response had been maintained. At present the patient is in a follow-up program to evaluate the duration of the complete response.
This case is worth mentioning since, to the best of our knowledge, it represents the first evidence of complete response to sorafenib in an elderly patient with advanced HCV-related HCC.
肝细胞癌（HCC）是世界上第五种最常见的肿瘤。过去，使用传统的抗肿瘤药物治疗晚期 HCC 并未取得满意的效果：最近，在这种患者人群中，口服多激酶抑制剂索拉非尼已能够在统计学上显著改善总生存期。与其他肿瘤类型中使用的其他抗血管生成药物一样，索拉非尼也很少引起通常与传统细胞毒性药物观察到的肿瘤尺寸缩小：从索拉非尼和其他正在开发的竞争对手的研究中收集的数据并未报告 HCV 诱导的 HCC 中存在任何完全缓解。
一位 84 岁的男性患有长期慢性 HCV 肝炎，因局灶性肝病变超声检查而转至我院。为了更好地描述肝脏疾病并明确局灶性肝病变的诊断，该患者被收入我院病房。实验室和仪器检查证实了 HCV 相关肝硬化的临床表现，并发现了一个约 6 厘米大小的肝脏病变，具有浸润性 HCC 并伴有门静脉主干血栓形成。由于疾病处于晚期，开始给予索拉非尼 400mg bid 治疗。自治疗开始一个月后，即观察到甲胎蛋白水平降低，第三个月时降至正常值范围内。此外，CT 扫描显示肿瘤病变缩小了 50%，同时门静脉主干通畅。第六个月时，甲胎蛋白水平在正常值下限处恢复正常，MRI 显示肿瘤完全消失。此外，还观察到金属蛋白酶血清水平降低。第十二个月时，进一步的 MRI 证实完全缓解得以维持。目前，该患者正在接受随访，以评估完全缓解的持续时间。
本病例值得一提，因为据我们所知，这是首例在晚期 HCV 相关 HCC 的老年患者中观察到索拉非尼完全缓解的证据。
