Sorafenib-induced acute-on-chronic liver failure in a patient with hepatocellular carcinoma after transarterial chemoembolization and radiofrequency ablation: A case report

Sorafenib-Induced Erythema Multiforme Major and Severe Hepatic Failure in Metastatic Hepatocellular Carcinoma: A Case Report

Sorafenib, a kinase inhibitor, is known to cause skin toxicity, which sometimes leads to treatment interruption or drug dose reduction. Erythema multiforme (EM) is one of these dermatologic toxicities induced by sorafenib. We report the case of a 28-year-old male with hepatocellular carcinoma (HCC). Two months after surgery, the patient presented with multiple metastases to the retroperitoneal lymph nodes and lungs. Therefore, systemic therapy with sorafenib was indicated. While receiving the medication, the patient presented signs compatible with EM. The signs occurred on the torso and then spread to the rest of the body. Sorafenib treatment was interrupted the same day when skin lesions appeared and moisturizers with topical steroids and oral antihistamines were prescribed. The skin lesions decreased in size but without significant cutaneous improvement. The patient showed biologically severe liver failure and radiological progression. Because of the severe hepatic failure, initiation of intravenous steroids and establishment of another line of chemotherapy following tumor progression were contraindicated. The decision of the multidisciplinary staff with patient consent was to proceed with the best supportive care. The patient died in ambulatory care 12 days after discharge and local treatment. This report highlights the possibility of developing severe EM while receiving sorafenib. Patients with HCC who have liver resection without liver dysfunction should not be administered sorafenib, or it must be used with caution at very low doses and accompanied by close and regular follow-ups to avoid disease progression and deaths.

Liver Pathology Related to Onco-Therapeutic Agents

Oncotherapeutic agents can cause a wide range of liver injuries from elevated liver functions tests to fulminant liver failure. In this review, we emphasize a newer generation of drugs including immune checkpoint inhibitors, protein kinase inhibitors, monoclonal antibodies, and hormonal therapy. A few conventional chemotherapy agents are also discussed.

Therapeutic efficacy of a Dioscorea membranacea extract in a rat model of hepatocellular carcinoma: Histopathological aspects

Hepatocellular carcinoma (HCC) is most common in adults and has a high mortality rate because of a lack of effective treatment options. We investigated the effect of a medicinal plant as a potential source of drugs against HCC. The rhizomes of Dioscorea membranacea Pierre (DM), Hua-Khao-Yen in Thai, are commonly used as ingredients for alternative treatment of cancer in Thailand. In this study, the anticancer effects of DM extract in HCC-bearing rats were evaluated with respect to gross morphology, histopathology, and leakage of liver enzymes. In untreated HCCs, typical features of liver cancer, including hepatic nodules, thick-cell cords, and pseudoglandular cell arrangements, were observed. In addition, the HCCs showed abnormal reticulin patterns and a high glypican3 expression. In HCC-bearing rats treated with DM the cancer areas and reticulin expression were significantly reduced compared to the untreated group (p < 0.01). Sorafenib, the standard drug to treat HCC, reduced the cancer area further, but increased leakage of liver enzymes and decreased serum albumin concentration, indicating liver toxicity. These findings suggest that DM has an anticancer effect on HCCs in an animal model in vivo with potentially less severe side effects than sorafenib. Therefore, further studies of DM’s mechanism of action in HCC should be carried out.

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DM exerted a mitigating effect on histopathology and membrane damage of HCC in rats.

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Its effect was similar to that of the standard drug sorafenib.

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It reduced the volume of cancer nodules without the serious hepatotoxic side effects seen after SF treatment.