scholarly journals Isolated Right Ventricular Metastasis in a Woman with Advanced Hepatocellular Carcinoma after Palliative Therapy

2019 ◽  
Vol 13 (3) ◽  
pp. 487-497
Author(s):  
Chun-Ting Fan ◽  
Wei-Wen Lin ◽  
Ming-Jer Chen ◽  
Sz-Iuan Shiu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Literature Review ◽  
Supportive Care ◽  
Right Ventricular ◽  
Palliative Therapy ◽  
Best Supportive Care ◽  
Optimal Treatment ◽  
Cardiac Metastasis ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc

Hepatocellular carcinoma (HCC) with cardiac metastasis represents a group of rarity and poor prognosis. Few case reports have described this patient entity, and it remains unclear regarding the optimal treatment and predicted outcome for these patients. In our case, we represented a 67-year-old female patient with presentations of dyspnea and heart murmur, which conducted to the diagnosis of advanced HCC with isolated right ventricular metastasis. Because of multiple comorbidities regarding cardiac and pulmonary systems, she received best supportive care and survived 2 months after initial diagnosis. A systemic literature review of 80 published cases (including our patient) since the 1950s was also performed from PubMed, and the data were gathered from the medical record and literature reviews. In our review, patients with advanced HCC and cardiac metastasis involved the right heart mainly with a predominance of right atrium (53%). Meanwhile the overall 3-month survival rate in our review was 70.7%. In subgroup analysis, the overall 3-month survival was highest (97%) in patients treated with surgery and other therapies, and lowest (27%) in patients with best supportive care. To our knowledge, this is the first comprehensive literature review addressing the epidemiology, optimal treatment, and prognosis for advanced-stage HCC with cardiac metastasis. We suggest that abnormal cardiac murmur in patients with history of HCC should prompt investigation for tumor involvement of the heart. We also emphasize individualized treatment as well as prognostic measurement accordingly.

scholarly journals Cost-Effectiveness of Cabozantinib in the Second-Line Treatment of Advanced Hepatocellular Carcinoma

2019 ◽  
Vol 17 (6) ◽  
pp. 669-675 ◽  
Author(s):  
Enrique Soto-Perez-de-Celis ◽  
Pedro N. Aguiar ◽  
Mónica L. Cordón ◽  
Yanin Chavarri-Guerra ◽  
Gilberto de Lima Lopes
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Supportive Care ◽  
Cost Effective ◽  
Best Supportive Care ◽  
Advanced Hepatocellular Carcinoma ◽  
Line Treatment ◽  
Second Line ◽  
Advanced Hcc ◽  
The Cost

Background: Treatment options are limited for patients with advanced hepatocellular carcinoma (HCC) that progresses after treatment with sorafenib. Cabozantinib, an oral small molecule inhibitor of multiple tyrosine kinase receptors, recently showed improved overall survival (OS) compared with placebo in sorafenib-pretreated patients with advanced HCC in the CELESTIAL trial. This study assessed the cost-effectiveness of cabozantinib for second-line treatment of patients with advanced HCC from a US healthcare system perspective. Patients and Methods: Cost and utility data were extracted from the CELESTIAL trial and used to determine the cost-effectiveness of cabozantinib compared with placebo plus best supportive care. The main outcome of this study was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained by using cabozantinib compared with placebo plus best supportive care in sorafenib-pretreated HCC. Results: In the base-case analysis using data from the CELESTIAL trial, the incremental QALY and ICER were 0.067 and $1,040,675 for cabozantinib compared with placebo and best supportive care. OS reported in the CELESTIAL trial (hazard ratio, 0.76; 95% CI, 0.63–0.92) had the strongest association with the ICER. In one-way sensitivity analyses, there were no scenarios in which cabozantinib was cost-effective. In a cost-threshold analysis, cabozantinib would have to be priced at least $50 per pill to be cost-effective considering a willingness to pay of $100,000 per QALY. Although the CELESTIAL trial demonstrated that cabozantinib improves OS compared with placebo in patients with HCC that progresses after treatment with sorafenib, our analysis shows that cabozantinib is not a cost-effective therapy in this scenario. Conclusions: At current costs, cabozantinib is not cost-effective for second-line therapy of HCC in the United States.

scholarly journals Advanced hepatocellular carcinoma treated by radiofrequency ablation combined with oncolytic virus and anti-PD-1 antibody therapy: a case report and literature review

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110445
Author(s):  
Anqing Xie ◽  
Feng Xia ◽  
Jun Pei ◽  
Ximing Sun ◽  
Zongtao Song
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Literature Review ◽  
Oncolytic Virus ◽  
Antibody Therapy ◽  
Human Adenovirus ◽  
Adenovirus Type ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc

The development of an effective therapy for advanced hepatocellular carcinoma (HCC) represents an important global concern. In recent years, the combination of multiple treatment methods with immunotherapy has achieved great progress in patients with advanced HCC. Patient survival has been significantly prolonged, but cases of complete response (CR) remain rare. Here, we report two cases in which CR was achieved by radiofrequency ablation combined with an oncolytic virus (recombinant human adenovirus type 5) and anti-programmed cell death protein 1 antibody. Additionally, a literature review is presented to describe similar advancements in this field and explore viable methods for the treatment of advanced HCC.

Comparative efficacy of S-1 versus best supportive care in advanced hepatocellular carcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 466-466
Author(s):  
Pengfei Yu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Supportive Care ◽  
Lymph Nodes ◽  
Randomized Clinical Trials ◽  
Locally Advanced ◽  
Elevated Serum ◽  
Best Supportive Care ◽  
Advanced Hepatocellular Carcinoma ◽  
Supraclavicular Lymph Nodes

466 Background: S-1, an oral fluoropyrimidine derivative, has been shown to be clinically effective against hepatocellular carcinoma (HCC). We carried out a retrospective study to evaluate the efficacy of S-1, compared to best supportive care (BSC) in patients with advanced hepatocellular carcinoma. Methods: From 2009.12 to 2013.12, 32 cases of advanced hepatocellular carcinoma (the presence of extrahepatic metastasis or locally advanced disease not amenable to surgical resection or other locoregional therapies) were retrospectively analysed. 18 patients received S-1 (80 mg/m2/day, administered during days 1~14 and repeated every 21 days) and 14 patients received best supportive care (BSC). The time to progression (TTP), overall survival (OS) and safety were assessed. Results: 17 of 32 (53.1%) patients had metastatic disease, including the retroperitoneal lymph nodes (7 cases), lung (4 cases), supraclavicular lymph nodes (3 cases), abdominal wall (3 cases), brain (2 cases) and adrenal glands (2 cases). 12 patients (37.5%) had portal vein tumor thrombus. The two groups were well matched at baseline. In S-1 group,a total of 63 cycles were administered with median of 3.5 cycles (range, 2~7).The most common grade 3/4 toxicities were thrombocytopenia (28.1%), neutropenia (21.8%), elevated serum aspartate aminotransferase levels (15.6%) and rash (9.4%). A patient (5.6%) had a partial response,11 (61.1%) had stable disease, and 6 (33.3%) had progressive disease. Median TTP was 4.7 months in the S-1 group compared with 2.3 months in the BSC group (P=0.013). Overall survival was 15.1 months in patients treated with S-1, compared with 8.3 months in those who received BSC (P=0.027). Conclusions: S-1 showed an acceptable safety profile and benefit in survival in patients with advanced HCC.The conclusion needs further evaluation in randomized clinical trials.

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