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A case of Hepato cellular carcinoma maintained a long partial response by low dose sorafenib with sever chronic renal dysfunction

A 65-year-old male with HCV-positive hepatocellular carcinoma (HCC) and right renal cell carcinoma was simultaneously treated by surgical resection. During follow-up, a solitary recurrence was found and cured by the radiofrequency ablation, but around then chronic renal failure as a complication of diabetes mellitus was get-ting worse up to 5.39 mg (cid:2) d l at the serum creatinine, abbreviated as sCr below, and considered to introduce into hemodialysis (HD). However, MRI examination revealed multiple recurrence of liver, the plan of introducing into HD was quitted, and the interventional therapy under the angiography was also given up. As the patientʼs liver function was the level of Child-Pugh A, the treatment with solafenib was made a plan in hospital. After admitted, he was treated with sorafenib at a starting dose of 400mg (cid:2) day in consideration of renal dysfunction. Seven days after initiation, the dose was reduced to 200 mg (cid:2) day because of appearing the grade 3 level of diarrhea. At 5 months after the administration of sorafenib, tumor markers, of which AFP and PIVKA-II were maximally at 3774 ng (cid:2) m l and 14995 mAU (cid:2) m l respectively were remarkably decreased to the normal level. MRI examination demonstrated the reduction of HCCs in size, and the therapeutic effect was considered as partial response by Response Evaluation Criteria in Solid tumors (RESIST). The enhanced ultrasonography showed no sign of blood flow in all of tumors, suggesting as a remarkable response to sorafenib. Of notice, the level of sCr was gradually down after use of sorafenib (sCr: 1.45 mg (cid:2) d l at March-13). Sorafenib treatment has been continued with dose of 200 mg (cid:2) day, and the tumor markers have been kept within normal limit even now.