Abstract | RATIONALE: PATIENT CONCERNS: In 2003, a 36-year-old woman was referred to the hospital with right upper abdominal pain. DIAGNOSIS: An initial ultrasound of the liver demonstrated a large unclear lesion of the left lobe of the liver. The magnet resonance imaging findings confirmed a multifocal inoperable HCC in a non-cirrhotic liver. Seven years after receiving a living donor LT, pulmonary and intra-hepatic recurrence of the HCC was radiologically diagnosed and histologically confirmed. INTERVENTIONS: Following an interdisciplinary therapy concept consisting of surgical, interventional-radiological (with radiofrequency ablation [RFA]) as well as systemic treatment, the patient achieved a survival of more than 10 years after tumor recurrence. As systemic first line therapy with sorafenib was accompanied by grade 3 to 4 toxicities, such as mucositis, hand-foot skin reaction, diarrhea, liver dysfunction, and hyperthyroidism, it had to be discontinued. After switching to cabozantinib from June 2018 to April 2020, partial remission of all tumor manifestations was achieved. The treatment of the remaining liver metastasis could be completed by RFA. The therapy with cabozantinib was well tolerated, only mild arterial hypertension and grade 1 to 2 mucositis were observed. Liver transplant function was stable during the therapy, no drug interaction with immunosuppressive drugs was observed. OUTCOMES: More than 10 years survival after recurrence of HCC after living-donor LT due to intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy with cabozantinib in the second line therapy. LESSONS: In conclusion, this report highlights the tolerability and effectiveness of cabozantinib for the treatment of HCC recurrence after LT. We show that our patient with a late recurrence of HCC after LT benefitted from intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy.
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Authors | Robert Mahn, Farsaneh Sadeghlar, Alexandra Bartels, Taotao Zhou, Tobias Weismüller, Patrick Kupczyk, Carsten Meyer, Florian C Gaertner, Marieta Toma, Tim Vilz, Petra Knipper, Tim Glowka, Steffen Manekeller, Jörg Kalff, Christian P Strassburg, Maria A Gonzalez-Carmona |
Journal | Medicine
(Medicine (Baltimore))
Vol. 100
Issue 38
Pg. e27082
(Sep 24 2021)
ISSN: 1536-5964 [Electronic] United States |
PMID | 34559100
(Publication Type: Case Reports, Journal Article)
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Copyright | Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. |
Chemical References |
- Anilides
- Pyridines
- cabozantinib
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Topics |
- Abdominal Pain
(etiology)
- Adult
- Anilides
(administration & dosage, therapeutic use)
- Carcinoma, Hepatocellular
(diagnosis, secondary, therapy)
- Combined Modality Therapy
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Humans
- Liver Neoplasms
(diagnosis, pathology, therapy)
- Liver Transplantation
- Molecular Targeted Therapy
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Postoperative Complications
(diagnosis, therapy)
- Pyridines
(administration & dosage, therapeutic use)
- Radiofrequency Ablation
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