Kawanami Gustavo Hideki, Katsuda Leopoldo, Rocha Thiara Barcelos, da Silva Yamashiro Fabio, Pelafsky Leonardo, Qi Xingshun, Romeiro Fernando Gomes
Fundação para o Desenvolvimento Médico e Hospitalar (FAMESP) Hospital Estadual de Bauru, São Paulo, Brazil.
Imagem Diagnósticos Médicos, Bauru, São Paulo, Brazil.
Can J Gastroenterol Hepatol. 2021 Jan 10;2021:6219896. doi: 10.1155/2021/6219896. eCollection 2021.
Hepatocellular carcinoma is a relevant cause of mortality worldwide, mainly among patients who have a prior liver disease. In spite of clear recommendations regarding surveillance and screening methods, most patients are still diagnosed only when they are no longer candidates to curative treatment modalities, while others do not achieve the goals of such treatments, thus increasing the need of anticancer drugs. Moreover, when cirrhotic patients begin to receive these drugs, many types of adverse events are seen as a reason to withdrawal, even when there are findings suggesting a good response to the treatment. . This case report is about a cirrhotic patient who received many types of treatment, from surgery and chemoembolization during early stages to first- and second-line systemic therapy when the disease turned to be advanced. Since he had no signs of liver dysfunction and suffered tumor progression during sorafenib treatment, regorafenib was initiated. The main findings that make this case important are the adverse events after taking this second-line agent, which would certainly be considered unacceptable and would lead to the drug withdrawal. The reasons why regorafenib was maintained are explained based on clinical and imaging findings, showing how this decision led to an excellent response.
The knowledge of the main adverse events described in the pilot clinical trials can avoid unnecessary withdrawal of regorafenib. In addition, some clinical and imaging findings can be deemed as predictors of good response to tyrosine kinase inhibitors.
肝细胞癌是全球范围内导致死亡的一个重要原因，主要发生在患有既往肝脏疾病的患者中。尽管对于监测和筛查方法有明确的建议，但大多数患者仍仅在不再适合接受根治性治疗方式时才被诊断出来，而其他患者则无法实现此类治疗的目标，因此对抗癌药物的需求增加。此外，当肝硬化患者开始接受这些药物治疗时，即使有迹象表明对治疗有良好反应，许多类型的不良事件也被视为停药的原因。本病例报告讲述的是一名肝硬化患者，他接受了多种治疗，从早期的手术和化疗栓塞到疾病进展后的一线和二线全身治疗。由于他在索拉非尼治疗期间没有肝功能障碍的迹象且出现了肿瘤进展，因此开始使用瑞戈非尼。使该病例具有重要意义的主要发现是服用这种二线药物后的不良事件，这些不良事件肯定会被认为是不可接受的，并会导致停药。基于临床和影像学发现解释了维持使用瑞戈非尼的原因，展示了这一决定如何带来了出色的反应。
了解先导临床试验中描述的主要不良事件可以避免不必要地停用瑞戈非尼。此外，一些临床和影像学发现可被视为对酪氨酸激酶抑制剂有良好反应的预测指标。
