Protracted Course of Relapsing-Remitting Fibrolamellar Hepatocellular Carcinoma in an Adolescent

Abstract

Hepatocellular carcinoma (HCC) is a global healthcare problem commonest in males with hepatic cirrhosis or hepatitis B virus infection. Fibrolamellar HCC is a subtype seen mainly in younger patients without conventional risk factors and perhaps has a somewhat more favorable prognosis than typical HCC. Here we report a case of fibrolamellar HCC presenting in an adolescent with a prolonged, relapsing-remitting course characterized by prolonged exposure to sorafenib including in the adjuvant context, use of adjuvant doxorubicin chemotherapy, resection of multiple metachronous pulmonary metastases and dramatic response to radiotherapy delivered as tomotherapy to her metastatic hilar lymphadenopathy. We speculate on the possible synergistic interactions between radiotherapy and her anti-angiogenic therapy and on what systemic treatment options might be open to her in the future including further targeted therapy and also immunotherapy including immune checkpoint blockade such as anti-CTLA4 and PD-1.




J Med Cases. 2015;6(3):113-118
doi: http://dx.doi.org/10.14740/jmc2060w