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Systemic treatment of hepatocellular carcinoma in a patient with hemophilia A: A case report

Introduction. Hepatocellular carcinoma is a serious problem for patients with
 hemophilia. Hepatitis C virus infection is the most common comorbidity in
 adult patients with inherited bleeding disorders, including hemophilia. Case
 Report. This is a case report of a 65-year-old male patient with hemophilia
 A and hepatocellular carcinoma. Sorafenib treatment was initiated at a dose
 of 400 mg/day, after a 50% dose reduction. In order to prevent bleeding
 episodes, prophylactic doses of replacement plasma-derived factor VIII
 concentrate (40 U/kg of body weight three times a week) were introduced. Our
 patient received a total of ten cycles of sorafenib therapy, in good general
 condition, without bleeding episodes. Conclusion. Differential chemotherapy
 is not contraindicated in patients with inherited bleeding disorders,
 provided that adequate hemostasis is achieved. In such cases, a
 multidisciplinary approach is necessary for the management of hemophilia
 during systemic cancer treatment.