Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, INF 410, 69120, Heidelberg, Germany.
Langenbecks Arch Surg. 2013 Dec;398(8):1123-8. doi: 10.1007/s00423-013-1114-1. Epub 2013 Oct 4.
Recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) is a rare but challenging condition. In most cases, the recurrent tumor is presented with extrahepatic spread. Therefore, systemic treatment with sorafenib has to be assessed. Because of a plethora of possible drug interactions, e.g., with immunosuppressant or anti-infective therapy, safety and feasibility of sorafenib treatment requires special attention.
We retrospectively analyzed 18 patients who suffered from recurrent advanced HCC after LT between January 2002 and December 2010 at the University Hospital Heidelberg regarding safety of sorafenib treatment and survival.
Results showed that 8 patients were eligible for treatment with sorafenib showing a median time to progression (TTP) of 4.5 months and an overall survival of 9 months. Most common side effects were grades I and II diarrhea and hand-foot syndrome (HFS) which could be managed by sorafenib dose reduction. No grade III or IV adverse events (AEs) were noticed. No patient had to discontinue treatment due to AEs. The ten patients not amenable for sorafenib treatment, due to initial poor performance status or its deterioration after first line treatment, were treated with surgical resection (n = 3), locoregional therapies (n = 1), or palliative radiation therapy (n = 1). They showed a median overall survival of 2.3 months.
Sorafenib may represent a therapeutic option for recurrent HCC after LT with manageable side effects. The clinical benefit of sorafenib in this setting is promising but needs to be confirmed in a prospective randomized trial.
肝移植（LT）后复发性肝细胞癌（HCC）是一种罕见但具有挑战性的情况。在大多数情况下，复发性肿瘤表现为肝外扩散。因此，必须评估索拉非尼的全身治疗。由于可能存在大量药物相互作用，例如与免疫抑制剂或抗感染治疗的相互作用，因此需要特别注意索拉非尼治疗的安全性和可行性。
我们回顾性分析了 2002 年 1 月至 2010 年 12 月在海德堡大学医院接受 LT 治疗后复发的晚期 HCC 患者 18 例，评估了索拉非尼治疗的安全性和生存率。
结果显示，8 例患者有资格接受索拉非尼治疗，中位无进展生存期（TTP）为 4.5 个月，总生存期为 9 个月。最常见的副作用是 1 级和 2 级腹泻和手足综合征（HFS），可通过降低索拉非尼剂量来控制。未发现 3 级或 4 级不良事件（AE）。没有患者因 AE 而停止治疗。由于初始体能状态较差或一线治疗后恶化而不适合索拉非尼治疗的 10 例患者，接受了手术切除（n=3）、局部区域治疗（n=1）或姑息性放射治疗（n=1）。他们的中位总生存期为 2.3 个月。
索拉非尼可能是 LT 后复发性 HCC 的一种治疗选择，副作用可控制。在这种情况下，索拉非尼的临床获益有希望，但需要在前瞻性随机试验中得到证实。
