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Successful treatment for sorafenib-induced liver dysfunction: a report of case with liver biopsy
Daisuke Kuroda1, Hiromitsu Hayashi1, Hidetoshi Nitta1
1Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Abstract:
Sorafenib is an oral multikinase inhibitor with anti-proliferative and anti-angiogenic effects and is used worldwide for the treatment of advanced or metastatic hepatocellular carcinoma (HCC). While the significant survival benefit of sorafenib in patients with advanced HCC was demonstrated, various treatment-related adverse events might happen. Of them, the incidence of drug-related severe liver dysfunction rarely occurs (<1 %) but is one of the serious adverse events by sorafenib. The authors highlight the case of a 71-year-old man with metastatic HCC with sorafenib-related fatal liver dysfunction (T-Bil 28.6 mg/dL, AST 1611 IU/L, ALT 1098 IU/L) 2 months later even without either intrahepatic viable HCC or hepatitis B virus (HBV) reactivation. Then, the liver dysfunction was improved following aggressive treatment using hyperbaric oxygen. A liver biopsy demonstrated cholestasis, degeneration, and necrosis in hepatocytes with lymphocyte infiltration. Thus, sorafenib rarely can induce liver dysfunction characterized by cholestatic and hepatocellular injury types, and it could be a fatal event. Clinicians should pay attention to any increase in the liver enzymes in these patients.
Insights
Sorafenib, used for advanced liver cancer (HCC), can rarely cause fatal liver dysfunction. Early detection of liver enzyme increases is crucial for patient safety.
Area of Science:
- Hepatology
- Oncology
- Pharmacology
Background:
- Sorafenib is a multikinase inhibitor for advanced hepatocellular carcinoma (HCC).
- While effective, sorafenib can cause adverse events, including rare but severe liver dysfunction (<1%).
Purpose of the Study:
- To highlight a rare case of fatal sorafenib-induced liver dysfunction.
- To describe the clinical presentation, pathological findings, and treatment of this adverse event.
Main Methods:
- Case report of a 71-year-old male with metastatic HCC treated with sorafenib.
- Analysis of liver function tests, liver biopsy results, and treatment response.
Main Results:
- The patient developed fatal liver dysfunction (high T-Bil, AST, ALT) 2 months after starting sorafenib.
- Liver biopsy showed cholestasis, hepatocyte injury, and inflammation.
- Aggressive treatment with hyperbaric oxygen led to improvement.
Conclusions:
- Sorafenib can induce severe, potentially fatal liver dysfunction with mixed cholestatic and hepatocellular injury.
- Close monitoring of liver enzymes is essential in patients receiving sorafenib.
- Hyperbaric oxygen may be a potential treatment for severe sorafenib-induced liver injury.
