A case of multiple hepatocellular carcinoma tumors with thoracic vertebra and adrenal gland metastases successfully treated with prolonged administration of reduced-dose regorafenib for more than 12 months

Abstract

A 60-year-old male with prior liver resection for S5 hepatocellular carcinoma (HCC) caused by hepatitis C virus infection experienced multiple HCC recurrences despite repeated treatments with percutaneous ethanol injection therapy and transcatheter arterial chemoembolization. Three months after beginning sorafenib, thoracic vertebra and adrenal gland metastases were detected by computed tomography (CT) and increases in intrahepatic HCC tumors were noted. His treatment was switched to 80 mg/day of regorafenib. Severe Grade 3 hand-foot syndrome was observed in the third week of regorafenib that required three weeks for improvement. However, AFP and PIVKA-II values decreased dramatically and CT imaging revealed the disappearance of intrahepatic and metastatic tumors. To address hand-foot syndrome symptoms, regorafenib was reduced to 40 mg/day via a revised treatment course of three weeks of administration and two weeks of withdrawal. The results of long-term regorafenib therapy of more than 12 months indicate that revising the drug dosage and duration is important for successful extended treatment.