内容紹介
Summary
Sorafenib is an oral multi-targeted tyrosine kinase inhibitor used in cases of unresectable advanced HCC that significantly improves progression-free and overall survival. Complete response(CR)is uncommon; however, if major or complete radiological response are obtained, the issue of the discontinuation of sorafenib remains unresolved. The present study reported a case of a 75-year-old man with non-hepatitis B and C virus-related cirrhosis and multiple recurrent HCCs following resection. In December 2010, a CT scan revealed multiple intrahepatic recurrence after TACE. Laboratory testing showed Child-Pugh class A cirrhosis and an alpha-fetoprotein level of over 20,000 ng/mL. Sorafenib(800 mg/day)was started in December 2010. The subsequent dynamic CT performed at the 6th month of therapy showed a partial response according to RECIST criteria and a complete response according to mRECIST. The AFP had decreased to within normal levels. In May 2012, the sorafenib dose was reduced(200 mg twice daily)due to side effects(skin reaction). In December 2013, treatment was stopped after confirmation of a CR associated with shrinkage of the HCC. The patient maintained this remission until June 2018, more than 54 months after the discontinuation of sorafenib therapy. The adverse events of sorafenib were reversible. Further reporting of similar cases should help in the design of treatment strategies after CR to sorafenib therapy.
要旨
ソラフェニブはMAPキナーゼ経路,VEGF受容体,PDGF受容体活性を併せて阻害することにより抗腫瘍効果を発揮する分子標的薬である。肝細胞癌にソラフェニブを投与し完全奏効(complete response: CR)が得られた後に投薬を中止し,4年間再発を認めていない症例を報告する。症例は75歳,男性。主訴は肝腫瘍。現病歴は2010年1月に肝腫瘍を指摘され3月に肝中央二区域切除を施行した。6月のCTにて肝両葉に多発再発を認めTACEを2回,TAIを1回施行したが奏効せず,12月よりソラフェニブを800 mg/dayにて投与開始した。2011年6月にmodified RECIST(mRECIST)にてCRとなり2013年12月に皮膚症状の副作用のため中止した。その後2018年6月まで54か月間再発を認めていない。ソラフェニブでのCRはまれでありCRが得られた後の中止の可否についてのコンセンサスはないが,中止が許容される可能性が示唆された。
目次
Sorafenib is an oral multi-targeted tyrosine kinase inhibitor used in cases of unresectable advanced HCC that significantly improves progression-free and overall survival. Complete response(CR)is uncommon; however, if major or complete radiological response are obtained, the issue of the discontinuation of sorafenib remains unresolved. The present study reported a case of a 75-year-old man with non-hepatitis B and C virus-related cirrhosis and multiple recurrent HCCs following resection. In December 2010, a CT scan revealed multiple intrahepatic recurrence after TACE. Laboratory testing showed Child-Pugh class A cirrhosis and an alpha-fetoprotein level of over 20,000 ng/mL. Sorafenib(800 mg/day)was started in December 2010. The subsequent dynamic CT performed at the 6th month of therapy showed a partial response according to RECIST criteria and a complete response according to mRECIST. The AFP had decreased to within normal levels. In May 2012, the sorafenib dose was reduced(200 mg twice daily)due to side effects(skin reaction). In December 2013, treatment was stopped after confirmation of a CR associated with shrinkage of the HCC. The patient maintained this remission until June 2018, more than 54 months after the discontinuation of sorafenib therapy. The adverse events of sorafenib were reversible. Further reporting of similar cases should help in the design of treatment strategies after CR to sorafenib therapy.
要旨
ソラフェニブはMAPキナーゼ経路,VEGF受容体,PDGF受容体活性を併せて阻害することにより抗腫瘍効果を発揮する分子標的薬である。肝細胞癌にソラフェニブを投与し完全奏効(complete response: CR)が得られた後に投薬を中止し,4年間再発を認めていない症例を報告する。症例は75歳,男性。主訴は肝腫瘍。現病歴は2010年1月に肝腫瘍を指摘され3月に肝中央二区域切除を施行した。6月のCTにて肝両葉に多発再発を認めTACEを2回,TAIを1回施行したが奏効せず,12月よりソラフェニブを800 mg/dayにて投与開始した。2011年6月にmodified RECIST(mRECIST)にてCRとなり2013年12月に皮膚症状の副作用のため中止した。その後2018年6月まで54か月間再発を認めていない。ソラフェニブでのCRはまれでありCRが得られた後の中止の可否についてのコンセンサスはないが,中止が許容される可能性が示唆された。