Z Gastroenterol 2019; 57(04): 501-507
DOI: 10.1055/a-0855-4469
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

Pharmakologische Therapie von Leberzellkarzinomen mit cavoatrialem Tumorthrombus – Fallserie und Literaturübersicht
Tianzuo Zhan*
1   Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
2   Division of Signaling and Functional Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
,
Janina Sollors*
1   Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Niels Steinebrunner
3   Department of Internal Medicine IV, University Hospital Heidelberg, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
,
Hans Jürgen Schlitt
4   Department of Surgery, University Medical Center, Regensburg, Germany
,
Christian Stroszczynski
5   Department of Radiology, University Medical Center, Regensburg, Germany
,
Karl Heinz Weiss
3   Department of Internal Medicine IV, University Hospital Heidelberg, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
,
Matthias P. Ebert
1   Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Andreas Teufel
1   Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
› Author Affiliations
Further Information

Publication History

12 November 2018

06 February 2019

Publication Date:
09 April 2019 (online)

Abstract

Hepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

Zusammenfassung

Hepatozelluläre Karzinome (HCC) mit Tumorthrombose in der Vena cava inferior und dem rechten Vorhof (CATT) sind mit einer schlechten Prognose assoziiert. In der Literatur wurden bisher vor allem chirurgische Therapieverfahren beschrieben, insbesondere die Hemihepatektomie mit Resektion des Tumorthrombus. Die meisten Patienten mit HCC werden jedoch im fortgeschrittenen Tumorstadium diagnostiziert oder haben eine eingeschränkte Leberfunktion, sodass eine chirurgische Therapie nicht möglich ist. Wir beschreiben hier drei Fälle von Patienten mit fortgeschrittenem HCC und CATT, die nach chirurgischer oder interventioneller Therapie einen Progress entwickelt haben und mit Sorafenib oder Nivolumab behandelt wurden. Bei allen drei Patienten wurde eine partielle Stabilisierung oder Remission der Erkrankung erreicht. Das Gesamtüberleben nach Diagnose eines CATT betrug 3 und 17 Monate für Sorafenib und 7 + Monate für Nivolumab. Im Vergleich zu anderen Behandlungsoptionen zeigte die Pharmakotherapie auch bei Patienten mit HCC und CATT ein vergleichbares Ergebnis. Sie sollte daher ein integraler Bestandteil eines multimodalen Therapiekonzepts sein.

* These authors contributed equally.


 
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