%0 Journal Article
%T Metastatic Hepatocellular Carcinoma Treated With Zoledronic Acid
%A Anthony L. Nguyen
%A Huynh Cao
%A Mie Mie Thinn
%J General Information | Journal of Oncology Practice
%D 2018
%R https://doi.org/10.1200/JOP.2017.023770
%X Section: ChooseTop of page <<REFERENCES Introduction Hepatocellular carcinoma (HCC) is an aggressive malignancy of the liver that often occurs in patients with cirrhosis and chronic viral hepatitis. Advanced-stage HCC has a dismal prognosis because of the underlying liver disease and lack of effective treatment options. Sorafenib is the first-line agent approved for metastatic HCC with Child-Pugh classification A and B, which has resulted in a median overall survival of 10.7 months.1 Recently, regorafenib was approved as a second-line agent, with median overall survival of 10.6 months.2 We present a case of metastatic HCC to the bones and lungs that was successfully treated with single-agent zoledronic acid with durable response in clinical symptoms, radiologic remission of lung metastases and stabilization of bone metastases, and significant downtrending of alpha-fetoprotein (AFP) levels. Case Report A 67-year-old male with untreated hepatitis C cirrhosis presented with right-sided upper-quadrant pain. A 4.2-cm liver mass was found on computed tomography (CT) scan, and the biopsy specimen was consistent with HCC. Clinical staging was T4aN0M0. The patient underwent liver mass resection. Six months after resection, AFP levels had increased to 4,397 ng/mL. A restaging CT and bone scan showed multiple bilateral lung nodules (Fig 1A) and bone metastases to the T9 vertebra and right-side anterior sixth rib. The overall clinical picture was consistent with metastatic HCC as a result of rising AFP levels and new radiologic lesions in the bilateral lungs and bones. Palliative radiation therapy was performed to the ribs and spine for 1 month. Zoledronic acid infusion 4 mg every 4 weeks was started for bone metastases and bone pain. The patient refused sorafenib because of concern about adverse effects. During follow-up, the patient¡¯s AFP levels declined rapidly to < 20 ng/mL within 3 months of starting zoledronic acid (Fig 1C). Follow-up CT scans showed interval decreases in size of metastatic lung nodules, and eventually, the lungs were clear of metastatic disease after 13 months of treatment (Fig 1B). Bone metastatic lesions in the T9 vertebra and right-side anterior sixth rib remained stable without new metastases. The patient has received zoledronic acid for the past 2 years with durable radiologic and AFP responses. Fig 1. (A) March 2015: Multiple noncalcified nodules in bilateral lung fields, with a 5 ¡Á 3-mm right-lower-lung nodule most prominent. Metastatic lytic lesions in right-side anterior sixth rib and T9 vertebra. (B) June 2016 to January 2017: No
%U http://ascopubs.org/doi/full/10.1200/JOP.2017.023770