title: Sorafenib for recurrence of hepatocellular carcinoma after liver transplantation.
abstract: BACKGROUND
  Recurrence of hepatocellular carcinoma after orthotopic liver transplantation not amenable to surgical approaches is associated with poor outcome.
  
  
  OBJECTIVE
  Retrospective evaluation of the safety and efficacy of sorafenib in patients with post-transplant hepatocellular carcinoma recurrence.
  
  
  METHODS
  Patients with post-transplant hepatocellular carcinoma recurrence were treated with sorafenib. Adverse events were assessed using National Cancer Institute Common Toxicity Criteria of AEs version 3.0, tumour response was evaluated according to Response Evaluation Criteria in Solid Tumours.
  
  
  RESULTS
  First-line therapy after recurrence was surgery (n=6), radiation therapy (n=1), chemotherapy (n=1), and sorafenib (n=3). Finally, 11 patients were treated with sorafenib. Nine patients (82%) received an additionally targeted therapy with sirolimus as part of their immunosuppressive regimen. Most common grade 3 adverse events included diarrhoea (46%), hand-foot skin reaction (27%), nausea, fatigue, and leucopoenia (all 18%). Sorafenib had to be discontinued in two patients due to adverse events and six additional patients required a dose adjustment. No deterioration of liver graft function occurred. Median time to progression was 4.1 months; however, patients were treated with ongoing sorafenib in case of clinical benefit (median 8.9 months). Median overall survival after initiation of sorafenib treatment was 20.1 months.
  
  
  CONCLUSIONS
  Sorafenib in combination with immunosuppression including sirolimus may be administered to patients with post-transplant hepatocellular carcinoma recurrence with acceptable toxicity and without deterioration of liver graft function.
authors.affiliation: Department of Internal Medicine I, University Medicine of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Weinmann
authors.forename: Ina Maria
authors.initials: IM
authors.lastname: Niederle
authors.forename: Sandra
authors.initials: S
authors.lastname: Koch
authors.forename: Maria
authors.initials: M
authors.lastname: Hoppe-Lotichius
authors.forename: Michael
authors.initials: M
authors.lastname: Heise
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.forename: Marcus
authors.initials: M
authors.lastname: Schuchmann
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.forename: Peter Robert
authors.initials: PR
authors.lastname: Galle
authors.forename: Marcus-Alexander
authors.initials: MA
authors.lastname: Wörns
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011725:Pyridines / Q000627:therapeutic use*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D000077157:Sorafenib; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D007166:Immunosuppressive Agents; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib; D020123:Sirolimus; D016559:Tacrolimus