Long-term treatment of advanced hepatocellular carcinoma with the tyrosine kinase inhibitor erlotinib (Tarceva)--a case report.
OBJECTIVE
Hepatocellular carcinoma (HCC) is the 5th most common human malignancy with an increasing incidence in western countries and still unsatisfactory median survival rates of 5 - 7 months. Currently, new treatments with biologicals (so-called "targed therapies") such as VEGF and EGF antibodies or tyrosine kinase inhibitors (e. g., sorafenib) are being tested in patients with HCC. Here we report a long-term treatment of an advanced, multifocal HCC with the tyrosine kinase inhibitor erlotinib (Tarceva).


METHODS
A 64-year-old man with newly diagnosed and histologically proven advanced HCC and hydropic liver cirrhosis (Child-Pugh B) was treated for 18 months (12 / 05 - 06 / 07) with erlotinib. In addition paracentesis was performed every 6 weeks to provide relief from ascites.


RESULTS
After 2 weeks of treatment with 100 mg erlotinib QD the patient developed a 3 degrees-4 degrees skin toxicity (haemorrhagic rush). Other major side effects did not occur. Erlotinib medication was stopped for 2 weeks and re-started at a reduced dose of 75 mg QD. Marker tumour lesions (No. 1: caudate lobe/No. 2: segment III), liver enzymes and synthesis parameters (albumin, prothrombin time/INR) and frequency of paracentesis remained stable during the 18 months of observation.


CONCLUSIONS
Erlotinib (Tarceva) appears to be an interesting treatment option for patients with advanced HCC. More clinical data and studies are needed to confirm this result.
Hass
H G
HG
Onkologie, Hämatologie und Palliativmedizin, Marienhospital Stuttgart, Stuttgart. holgerhass@vinzenz.de
Denzlinger
C
C
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003875:Drug Eruptions / Q000209:etiology; D000069347:Erlotinib Hydrochloride; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011799:Quinazolines / Q000627:therapeutic use*; D014463:Ultrasonography
D000970:Antineoplastic Agents; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride