A unique bleeding-related complication of sorafenib, a tyrosine kinase inhibitor, in advanced hepatocellular carcinoma: a case reportReportar como inadecuado

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Journal of Medical Case Reports

, 8:72

First Online: 26 February 2014Received: 20 September 2013Accepted: 16 December 2013DOI: 10.1186-1752-1947-8-72

Cite this article as: Kang, H.Y., Moon, S.H. & Song, I.H. J Med Case Reports 2014 8: 72. doi:10.1186-1752-1947-8-72


IntroductionSorafenib, a multikinase inhibitor as a standard of care for advanced hepatocellular carcinoma, may lead endothelial cells to an unstable state by blocking the signaling pathway of vascular endothelial growth factor receptor, which may result in the disruption of the architecture and integrity of the microvasculature, and eventually increase the risk of hemorrhage. Hemobilia is a relatively uncommon condition as a consequence of hepatocellular carcinoma and its risk factors remain uncertain.

Case presentationHere we report a unique case of hemobilia occurring in a 55-year-old Korean man with hepatitis B virus-related hepatocellular carcinoma on Barcelona Clinic Liver Cancer advanced stage after seven days of treatment with sorafenib. He had received prior radiation therapy. Endoscopy revealed bleeding from the major duodenal papilla and endoscopic retrograde cholangiography revealed an amorphous filling defect throughout the common bile duct. Blood clots were removed by balloon sweeping and a nasobiliary drainage tube was placed. No further bleeding has been detected as of eight months after discontinuation of sorafenib.

ConclusionSorafenib may increase the risk of biliary bleeding in hepatocellular carcinoma patients who were primed with irradiation, by blocking the signaling pathway of the vascular endothelial growth factor receptor. Therefore, sorafenib should be used with caution in patients with advanced hepatocellular carcinoma, especially when combined with radiation therapy.

KeywordsHepatocellular carcinoma Sorafenib Tyrosine kinase inhibitor Hemobilia Complication AbbreviationsCTComputed tomography

HCCHepatocellular carcinoma

VEGFVascular endothelial growth factor.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-72 contains supplementary material, which is available to authorized users.

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Autor: Ha Yan Kang - Sung Hoon Moon - Il Han Song

Fuente: https://link.springer.com/

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