A case of recurrent hepatocellular carcinoma with obstructive jaundice treated successfully with biliary drainage and sorafenib

Abstract

A 73-year-old man who had previously undergone surgical therapy four times for hepatocellular carcinoma (HCC) was admitted for obstructive jaundice due to hilar and hepatoduodenal ligament lymph node metastases. Firstly, he was treated with endoscopic biliary drainage. Although the serum total bilirubin level was still as high as 7.5 mg/dl and his Child-Pugh classification was grade C, we started to administer sorafenib (800 mg/day) because his Child-Pugh class had been grade A before jaundice and the tumors had grown on CT images. The patient showed no remarkable adverse events, and his serum bilirubin level decreased gradually. After sorafenib therapy for 7 months, the lymph node metastases declined in size on CT images and the alpfa-fetoprotein level decreased to 10 ng/mL from 165 ng/ml. This response persisting for more than a year was evaluated as Partial Response (PR) by Response Evaluation Criteria in Solid Tumors criteria (RECIST) and modified RECIST (mRECIST) criteria. Our case suggested that sorafenib therapy can be an alternative treatment for advanced HCC with obstructive jaundice in case with effective biliary drainage and good liver reserve (Child-Pugh A). © 2013 The Japan Society of Hepatology.