EP112 – A rare case of sorafenib induced liver Injury in a patient with recurrent hurthle cell cancer

     

    Shikdar, Sufana1; Barry, Oumoul2; Choi,Eugene3
    1 Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA, USA
    2 Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA, USA
    3 Department of Hemato-Oncology, Mercy Catholic Medical Center, Darby, PA, USA

     

    Background: Sorafenib (Nexavar ®), a multikinase inhibitor, has recently been approved by the FDA for metastatic, radio-resistant Hurthle Cell Carcinoma. Sorafenib induced liver injury is a rare side effect where the pathogenesis is still unknown. Multiple Sorafenib induced liver injury cases are reported, but the majority of the cases occur in the patient with hepatocellular or renal cell carcinoma. Sorafenib induced liver injury in terminally ill patients result in mortality, morbidity and poor quality of life outcome. Patients can be prematurely withdrawn or discontinued from the treatment due to the adverse effects, which may limit the usefulness of this medication.

    Case Presentation: We report a case of metastatic, radioresistant Hurthle Cell Carcinoma (HCC) who was treated with Sorafenib. After 1 month of treatment, the patient required hospitalization for clinical and laboratory evidence of Drug Induced Liver Injury (DILI) due to Sorafenib. There was no prior history of hepatic pathology and detailed investigations were unremarkable. Her symptoms and liver function test improved within 10 days of discontinuing the drug. Unfortunately, she refused any further chemotherapy and elected hospice care for comfort measure.

    Conclusion:
    Despite the identification of the DILI, the pathophysiology and treatment options remain poorly understood. Timely diagnosis and appropriate treatment regarding Sorafenib induced liver injury is imperative to improve patient’s quality of life, and prevent mortality.

     

    References:

    1. Phitayakorn, Roy, and Christopher R. McHenry. “Follicular and Hürthle cell carcinoma of the thyroid gland.” Surgical oncology clinics of North America 15.3 (2006): 603-623.
    2. Blanchet, Benoit, et al. “Toxicity of sorafenib: clinical and molecular aspects.” Expert opinion on drug safety 9.2 (2010): 275-287.
    3. Brose, Marcia S., et al. “Rationale and design of decision: a double-blind, randomized, placebo-controlled phase III trial evaluating the efficacy and safety of sorafenib in patients with locally advanced or metastatic radioactive iodine (RAI)-refractory, differentiated thyroid cancer.” BMC cancer 11.1 (2011): 1.
    4. Gupta-Abramson, Vandana, et al. “Phase II trial of sorafenib in advanced thyroid cancer.” Journal of Clinical Oncology 26.29 (2008): 4714-4719.
    5. Chalasani, Naga P., et al. “ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury.” The American journal of gastroenterology 109.7 (2014): 950-966.
    6. Bible, Keith C., and Mabel Ryder. “Evolving molecularly targeted therapies for advanced-stage thyroid cancers.” Nature Reviews Clinical Oncology (2016).
    7. Van Hootegem, Anneleen, Chris Verslype, and Werner Van Steenbergen. “Sorafenib-induced liver failure: A case report and review of the literature.” Case reports in hepatology 2011 (2011).
    8. Fairfax, B. P., et al. “Fatal case of sorafenib-associated idiosyncratic hepatotoxicity in the adjuvant treatment of a patient with renal cell carcinoma.” BMC cancer 12.1 (2012): 1.
    9. Fallahi, Poupak, et al. “Sorafenib and thyroid cancer.” BioDrugs 27.6 (2013): 615-628.
    10. Sorafenib in DTC Monograph Addendum. National Drug Monograph Addendum. May 2015. VA Pharmacy Benefits Management Services Medical Advisory Panel, and VISN Pharmacist Executives. Retreived on 11 November, 2016 from chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.pbm.va.gov/PBM/clinicalguidance/drugmonographs/Sorafenib_in_Differentiated_Thyroid_Carcinoma_Addendum.pdf
    11. Jean, Gary W., et al. “Toxic Effects of Sorafenib in Patients With Differentiated Thyroid Carcinoma Compared With Other Cancers.” JAMA oncology 2.4 (2016): 529-534.

     

 

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