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Sorafenib treatment is save and may affect survival of recurrent hepatocellular carcinoma after liver transplantation

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Abstract

Introduction

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.

Materials and methods

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

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.

Conclusion

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.

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Financial disclosure

JP has no financial disclosures. TG and RK received funding from Bayer.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, INF 410, 69120, Heidelberg, Germany

    Jan Pfeiffenberger, Ronald Koschny, Wolfgang Stremmel & Tom M. Ganten

  2. Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Katrin Hoffmann, Arianeb Mehrabi & Peter Schemmer

  3. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany

    Anne Schmitz & Boris Radeleff

Authors
  1. Jan Pfeiffenberger
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  2. Ronald Koschny
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  3. Katrin Hoffmann
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  4. Arianeb Mehrabi
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  5. Anne Schmitz
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  6. Boris Radeleff
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  7. Wolfgang Stremmel
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  8. Peter Schemmer
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  9. Tom M. Ganten
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Corresponding author

Correspondence to Tom M. Ganten.

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Pfeiffenberger, J., Koschny, R., Hoffmann, K. et al. Sorafenib treatment is save and may affect survival of recurrent hepatocellular carcinoma after liver transplantation. Langenbecks Arch Surg 398, 1123–1128 (2013). https://doi.org/10.1007/s00423-013-1114-1

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  • DOI: https://doi.org/10.1007/s00423-013-1114-1

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