title: Sorafenib in a patient with advanced hepatocellular carcinoma and serious impairment of left ventricular function: a case report.
abstract: BACKGROUND
  sorafenib, a tyrosine-kinase inhibitor, is widely used in the treatment of advanced hepatocellular carcinoma. Drug-related toxicities are generally mild but sorafenib, as other similar agents, may induce elevation of systemic arterial blood pressure levels in relation to an interaction with cardiovascular system probably mediated by HIF pathway. This side effect may be particularly critical for patients with underlying serious heart disease as it can induce acute heart failure, a life-threatening condition, and usually such patients are excluded from active treatment with tyrosine-kinase inhibitors. We report the case of a patient affected by advanced hepatocellular carcinoma and serious impairment of cardiac function treated with sorafenib without any worsening of heart function. To our knowledge this is the first report of this kind in the literature.
  
  
  METHODS
  We report the case of a 74-year-old patient affected by advanced multifocal HCV-cirrhosis related hepatocellular carcinoma and severe post-ischemic fall of left-ventricular function with serious risk of cardiac functional impairment. The patient presented with an ECOG performance status of 0. Blood chemistry tests showed a substantial elevation of alpha-fetoprotein values and slight increases of bilirubin, of gamma-GT and of GOT; the absence of encephalopathy and ascites and the normality of coagulation parameters and of albumin led to classify the patient into the functional class Child-Pugh A. The patients was successfully treated with sorafenib at the reduced daily dose of 400 mg for long-time without any worsening of heart function.
  
  
  CONCLUSIONS
  The presented case can offer to oncologists a clinical support to take into consideration when deciding to treat with sorafenib advanced hepatocellular carcinoma patients presenting with serious impairment of cardiac function that are usually excluded from an active treatment.
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Valsuani
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Olimpia
authors.initials: O
authors.lastname: Siclari
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Camerini
authors.affiliation: Cardiology Division, Ospedale San Sebastiano, via Circondaria 1, 42015 Correggio (RE), Italy.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Canale
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Rondini
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Donati
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Puccinelli
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Gianna
authors.initials: G
authors.lastname: Tartarelli
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Cheti
authors.initials: C
authors.lastname: Puccetti
authors.affiliation: Medical Oncology Division, Versilia Hospital, via Aurelia 335, 55041 Lido di Camaiore (LU), Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Amoroso