Sorafenib from palliative to neoadjuvant chemotherapy in hepatocellular carcinoma with major vascular invasion: experience of two cases

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the incidence is higher in cirrhosis. Treatment options depend on tumor stage, status of liver function, and the general condition of the patient. Major vascular invasion is a contraindication for liver transplantation. Sorafenib has been found to be useful in association with transarterial chemoembolization as an effective chemotherapeutic agent to prolong survival in inoperable HCCs. Here we describe our experience where sorafenib was used as palliation but later turned out to be a neoadjuvant. Both cases had major portal vein thrombosis and received sorafenib as palliative therapy. After a mean use of 6 months, both patients had marked tumor response and proceeded to have liver transplantations. Both cases are tumor-free at a median follow up of 13 months.