Long-term treatment of advanced hepatocellular carcinoma with the tyrosine kinase inhibitor erlotinib (Tarceva)--a case report.

AIM: Hepatocellular carcinoma (HCC) is the 5th most common human malignancy with an increasing incidence in western countries and still unsatisfactory median survival rates of 5 - 7 months. Currently, new treatments with biologicals (so-called "targed therapies") such as VEGF and EGF antibodies or tyrosine kinase inhibitors (e. g., sorafenib) are being tested in patients with HCC. Here we report a long-term treatment of an advanced, multifocal HCC with the tyrosine kinase inhibitor erlotinib (Tarceva). PATIENT AND METHODS: A 64-year-old man with newly diagnosed and histologically proven advanced HCC and hydropic liver cirrhosis (Child-Pugh B) was treated for 18 months (12 / 05 - 06 / 07) with erlotinib. In addition paracentesis was performed every 6 weeks to provide relief from ascites.
RESULTS: After 2 weeks of treatment with 100 mg erlotinib QD the patient developed a 3 degrees-4 degrees skin toxicity (haemorrhagic rush). Other major side effects did not occur. Erlotinib medication was stopped for 2 weeks and re-started at a reduced dose of 75 mg QD. Marker tumour lesions (No. 1: caudate lobe/No. 2: segment III), liver enzymes and synthesis parameters (albumin, prothrombin time/INR) and frequency of paracentesis remained stable during the 18 months of observation.
CONCLUSIONS: Erlotinib (Tarceva) appears to be an interesting treatment option for patients with advanced HCC. More clinical data and studies are needed to confirm this result.