- Email: [email protected]
Lung Lesion With HCC—Not Always Metastasis
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
Neoplasms 1
CONFLICTS OF INTEREST
COMBINATION OF TACE AND SORAFENIB IMPROVES OUTCOMES IN BCLC STAGES B/C OF HEPATOCELLULAR CARCINOMA: A SINGLE CENTRE EXPERIENCE
The authors have none to declare.
Global Health City, Chennai, India
Background and Aim: Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of TACE + sorafenib in BCLC stages B/C. Methods: We performed a retrospective analysis on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/ C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival. Results: Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLC-C. Baseline characteristics were comparable in the groups. The predominant etiology of cirrhosis was NASH in both groups (37.2% and 38.5%, P = NS). 49.1% in BCLC-B and 56.9% in BCLCC had received TACE + sorafenib. In BCLC-B, the overall survival improved from 9months (95%CI 6.3–11.7) using TACE only to 16months (95%CI 12.9–19.1) using TACE + sorafenib (P < 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4months (95%CI 3–5) to 9 months (95%CI 6.8–11.2) (P < 0.0001). As per mRECIST criteria, patients on TACE + sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (P < 0.0001) in BCLC-C but not in BCLCB group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted. Conclusion: TACE + sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients. © 2016, INASL
http://dx.doi.org/10.1016/j.jceh.2016.06.106
2 LUNG LESION WITH HCC—NOT ALWAYS METASTASIS Pavan B. Hanchanale, Dinesh Jothimani, Joy Varghese, Venkataraman Jayanthi, Mohamed Rela Global Health city, Chennai, India
Background: We present a unique case of synchronous cancers—primary HCC and primary pulmonary carcinoid tumor. Case Report: A 65-year-old lady, case of HCV related decompensated cirrhosis with HCC was referred to our hospital for liver transplant. On examination she was pale and had a firm, non tender nodular liver palpable 2 cm below right costal margin. Baseline laboratory evaluation revealed total Bilirubin0.86 mg%, Albumin-2.3 gm/dL, AST-160 m/dL, ALT134 m/dL and INR-1.28. Her AFP was elevated (29.8 IU/ml). CECT abdomen showed cirrhosis with arterial enhancing lesions with delayed washout noted in segment 2 (14 mm 14 mm), segment 5/ 6 (14 mm 15 mm) & segment 6 (10 mm 8 mm, 10 mm 7 mm) without vascular invasion and presence of right lower lobe subpleural nodule. HRCT thorax revealed 7.2 mm nodular soft tissue density seen in superior basal segment of right lower lobe. Bone scan revealed no bone metastasis. As liver lesions were less than 2 cm in size without vascular invasion, she underwent biopsy of lung lesion with excision of right lower interlobar lymphnodes to rule out lung metastasis. Biopsy revealed well differentiated neuroendocrine tumor without necrosis and surgical margin free of tumor. Lymphnode biopsy revealed metastatic well differentiated carcinoid (IHC—HepPar-1 and Glypican-3 negative, Chromogranin, synaptophysin, CD-56, TTF-1 positive with Ki67 of 5%). She underwent Tc-99m-HYNIC-TOC (Octerotide) scan along with SPECT imaging revealed no distant metastasis. The multifocal liver lesions in both lobes of liver did not show radiolabelled
Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S63–S73
Neoplasms
Joy Varghese, Chandan Kedarisetty, Jayanthi Venkataraman, Kavya Harika, Vijaya Sreenivasan, Tiruchunapalli Deepashree, Mangerira Uthappa, Kaliamurthy Ilankumaran, Sanjay Govil, Mettu Reddy, Mohamed Rela
Corresponding author: Joy Varghese. E-mail: [email protected]
NEOPLASMS
octreotide uptake. Biopsy from liver lesion revealed well differentiated hepatocellular carcinoma (IHC— Glutamine synathase, CK7, CD34, Glypican 3, HSP70 positive). In view of HCC with lung NET she was not a candidate for liver transplant and underwent TACE with sorafinib. Conclusion: Atypical lung lesions in patient with HCC without vascular invasion will require evaluation as not all lung lesions are metastatic.
treatment, however in our case there is a near complete regression of hepatoma with sorafenib alone. Further prospective studies might pave way for use of Sorafenib as a curative treatment options for HCC irrespective of the stage of the disease.
CONFLICTS OF INTEREST
Corresponding author: Vishnu V. Reddy. E-mail: [email protected]
The authors have none to declare.
http://dx.doi.org/10.1016/j.jceh.2016.06.108
CONFLICTS OF INTEREST The authors have none to declare.
Corresponding author: Pavan B. Hanchanale. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.107
3 REGRESSION OF LARGE UNRESECTABLE HEPATOMA WITH SORAFENIB Neoplasms
Vishnu V. Reddy, P.V. Girish, Tarun Joseph, G. Balaji, Vishnu A. Raju, Mallikarjun Patil, Harshad Devarbhavi St Johns Medical College, Bengaluru, India
Background: Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. Currently, Sorafenib is the only systemic treatment modality approved for unresectable or metastatic HCC, which has demonstrated efficacy in improving Progression-Free Survival (PFS). Complete response of the tumor to sorafenib has never been documented. Case Description: 51-year-old gentleman presented in October 2013 with history of mild upper abdominal pain abdomen for two weeks No other abdominal complaints were noted. His past and personal history was unremarkable. Physical examination showed hepatomegaly and icterus. CECT abdomen showed 10 cm 9 cm mass in the right lobe of liver with portal vein thrombosis. AFP levels were 438 ng/ dl. HCV antibodies were positive. He was diagnosed to have chronic HCV infection with HCC in BCLC stage C. Patient was started on Sorafenib. Repeat CECT after 1 year showed regression of the lesion to 1.7 cm with patent portal vein. Patient received treatment for genotype 1. As of May 2016, patient is asymptomatic, compensated and doing well. Conclusion: Sorafenib has only been a palliative treatment modaility for HCC. Radiologically evident partial or complete response is rare after sorafenib S64
4 MACROPHAGE INFLAMMATORY PROTEIN1ALPHA/CC CHEMOKINE LIGAND 3 AND TUMOR-ASSOCIATED MACROPHAGES IN HEPATITIS C VIRUS-RELATED HEPATOCELLULAR CARCINOMA: RELATION TO TUMOR PROGRESSION AND ANGIOGENESIS Hoda E. Aggan, Myriam Helmy, Nevine E. Deeb, Ahmed Zeid, Mohamed Fawzy University of Alexandria, Alexandria, Egypt
Background and Aim: Hepatitis C virus (HCV) is a major risk factor for hepatocellular carcinoma (HCC). Chemokines induce leukocyte migration and activate inflammatory response and have recently been implicated in tumor growth. The present work was designed to study the role of macrophage inflammatory protein1alpha/CC chemokine ligand 3 (MIP-1alpha/CCL3) in the pathogenesis of HCV-related HCC in relation to tumor progression and angiogenesis. Methods: Thirty patients with HCV-related cirrhosis (15 patients with HCC and 15 patients without HCC) and 15 healthy subjects were enrolled in the study. Serum levels of MIP-1alpha/CCL3 were measured using enzyme linked immunosorbant assay and its sensitivity and specificity in the diagnosis of HCC was determined. Histological tumor grading was evaluated and the surrounding liver tissue was examined to assess histological activity index (HAI) and steatosis grade. Expressions of MIP-1alpha/ CCL3, CD68 [for tumor-associated macrophages (TAM)] and endoglin (CD105) [for determination of microvessel density (MVD)] were studied in HCC and adjacent non-neoplastic liver tissues by immunohistochemistry. © 2016, INASL
Neoplasms 1
CONFLICTS OF INTEREST
COMBINATION OF TACE AND SORAFENIB IMPROVES OUTCOMES IN BCLC STAGES B/C OF HEPATOCELLULAR CARCINOMA: A SINGLE CENTRE EXPERIENCE
The authors have none to declare.
Global Health City, Chennai, India
Background and Aim: Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of TACE + sorafenib in BCLC stages B/C. Methods: We performed a retrospective analysis on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/ C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival. Results: Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLC-C. Baseline characteristics were comparable in the groups. The predominant etiology of cirrhosis was NASH in both groups (37.2% and 38.5%, P = NS). 49.1% in BCLC-B and 56.9% in BCLCC had received TACE + sorafenib. In BCLC-B, the overall survival improved from 9months (95%CI 6.3–11.7) using TACE only to 16months (95%CI 12.9–19.1) using TACE + sorafenib (P < 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4months (95%CI 3–5) to 9 months (95%CI 6.8–11.2) (P < 0.0001). As per mRECIST criteria, patients on TACE + sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (P < 0.0001) in BCLC-C but not in BCLCB group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted. Conclusion: TACE + sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients. © 2016, INASL
http://dx.doi.org/10.1016/j.jceh.2016.06.106
2 LUNG LESION WITH HCC—NOT ALWAYS METASTASIS Pavan B. Hanchanale, Dinesh Jothimani, Joy Varghese, Venkataraman Jayanthi, Mohamed Rela Global Health city, Chennai, India
Background: We present a unique case of synchronous cancers—primary HCC and primary pulmonary carcinoid tumor. Case Report: A 65-year-old lady, case of HCV related decompensated cirrhosis with HCC was referred to our hospital for liver transplant. On examination she was pale and had a firm, non tender nodular liver palpable 2 cm below right costal margin. Baseline laboratory evaluation revealed total Bilirubin0.86 mg%, Albumin-2.3 gm/dL, AST-160 m/dL, ALT134 m/dL and INR-1.28. Her AFP was elevated (29.8 IU/ml). CECT abdomen showed cirrhosis with arterial enhancing lesions with delayed washout noted in segment 2 (14 mm 14 mm), segment 5/ 6 (14 mm 15 mm) & segment 6 (10 mm 8 mm, 10 mm 7 mm) without vascular invasion and presence of right lower lobe subpleural nodule. HRCT thorax revealed 7.2 mm nodular soft tissue density seen in superior basal segment of right lower lobe. Bone scan revealed no bone metastasis. As liver lesions were less than 2 cm in size without vascular invasion, she underwent biopsy of lung lesion with excision of right lower interlobar lymphnodes to rule out lung metastasis. Biopsy revealed well differentiated neuroendocrine tumor without necrosis and surgical margin free of tumor. Lymphnode biopsy revealed metastatic well differentiated carcinoid (IHC—HepPar-1 and Glypican-3 negative, Chromogranin, synaptophysin, CD-56, TTF-1 positive with Ki67 of 5%). She underwent Tc-99m-HYNIC-TOC (Octerotide) scan along with SPECT imaging revealed no distant metastasis. The multifocal liver lesions in both lobes of liver did not show radiolabelled
Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S63–S73
Neoplasms
Joy Varghese, Chandan Kedarisetty, Jayanthi Venkataraman, Kavya Harika, Vijaya Sreenivasan, Tiruchunapalli Deepashree, Mangerira Uthappa, Kaliamurthy Ilankumaran, Sanjay Govil, Mettu Reddy, Mohamed Rela
Corresponding author: Joy Varghese. E-mail: [email protected]
NEOPLASMS
octreotide uptake. Biopsy from liver lesion revealed well differentiated hepatocellular carcinoma (IHC— Glutamine synathase, CK7, CD34, Glypican 3, HSP70 positive). In view of HCC with lung NET she was not a candidate for liver transplant and underwent TACE with sorafinib. Conclusion: Atypical lung lesions in patient with HCC without vascular invasion will require evaluation as not all lung lesions are metastatic.
treatment, however in our case there is a near complete regression of hepatoma with sorafenib alone. Further prospective studies might pave way for use of Sorafenib as a curative treatment options for HCC irrespective of the stage of the disease.
CONFLICTS OF INTEREST
Corresponding author: Vishnu V. Reddy. E-mail: [email protected]
The authors have none to declare.
http://dx.doi.org/10.1016/j.jceh.2016.06.108
CONFLICTS OF INTEREST The authors have none to declare.
Corresponding author: Pavan B. Hanchanale. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.107
3 REGRESSION OF LARGE UNRESECTABLE HEPATOMA WITH SORAFENIB Neoplasms
Vishnu V. Reddy, P.V. Girish, Tarun Joseph, G. Balaji, Vishnu A. Raju, Mallikarjun Patil, Harshad Devarbhavi St Johns Medical College, Bengaluru, India
Background: Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. Currently, Sorafenib is the only systemic treatment modality approved for unresectable or metastatic HCC, which has demonstrated efficacy in improving Progression-Free Survival (PFS). Complete response of the tumor to sorafenib has never been documented. Case Description: 51-year-old gentleman presented in October 2013 with history of mild upper abdominal pain abdomen for two weeks No other abdominal complaints were noted. His past and personal history was unremarkable. Physical examination showed hepatomegaly and icterus. CECT abdomen showed 10 cm 9 cm mass in the right lobe of liver with portal vein thrombosis. AFP levels were 438 ng/ dl. HCV antibodies were positive. He was diagnosed to have chronic HCV infection with HCC in BCLC stage C. Patient was started on Sorafenib. Repeat CECT after 1 year showed regression of the lesion to 1.7 cm with patent portal vein. Patient received treatment for genotype 1. As of May 2016, patient is asymptomatic, compensated and doing well. Conclusion: Sorafenib has only been a palliative treatment modaility for HCC. Radiologically evident partial or complete response is rare after sorafenib S64
4 MACROPHAGE INFLAMMATORY PROTEIN1ALPHA/CC CHEMOKINE LIGAND 3 AND TUMOR-ASSOCIATED MACROPHAGES IN HEPATITIS C VIRUS-RELATED HEPATOCELLULAR CARCINOMA: RELATION TO TUMOR PROGRESSION AND ANGIOGENESIS Hoda E. Aggan, Myriam Helmy, Nevine E. Deeb, Ahmed Zeid, Mohamed Fawzy University of Alexandria, Alexandria, Egypt
Background and Aim: Hepatitis C virus (HCV) is a major risk factor for hepatocellular carcinoma (HCC). Chemokines induce leukocyte migration and activate inflammatory response and have recently been implicated in tumor growth. The present work was designed to study the role of macrophage inflammatory protein1alpha/CC chemokine ligand 3 (MIP-1alpha/CCL3) in the pathogenesis of HCV-related HCC in relation to tumor progression and angiogenesis. Methods: Thirty patients with HCV-related cirrhosis (15 patients with HCC and 15 patients without HCC) and 15 healthy subjects were enrolled in the study. Serum levels of MIP-1alpha/CCL3 were measured using enzyme linked immunosorbant assay and its sensitivity and specificity in the diagnosis of HCC was determined. Histological tumor grading was evaluated and the surrounding liver tissue was examined to assess histological activity index (HAI) and steatosis grade. Expressions of MIP-1alpha/ CCL3, CD68 [for tumor-associated macrophages (TAM)] and endoglin (CD105) [for determination of microvessel density (MVD)] were studied in HCC and adjacent non-neoplastic liver tissues by immunohistochemistry. © 2016, INASL