Sustained Complete Remission of Metastatic Hepatocellular Carcinoma with Single Agent Sorafenib

Hepatocellular carcinoma (HCC) is the third highest cause of cancer-related death, with 626,000 deaths worldwide annually [1]. Additionally, the incidence rate in the developed world is increasing, with an estimated incidence of 81,000 new cases per year [1]. The standard treatment regimen for HCC is dependent on whether the patient has local or metastatic disease. Local disease is treated with radio-ablation, resection, trans-arterial chemo-embolization, and/or orthotopic liver transplant. These treatments can produce 5-year survival rates up to 60–70 % [2]. However, the average survival for patients with metastatic disease is 7.9 months [3]. Sorafenib is a small molecule serine/threonine/tyrosine kinase inhibitor that, in the 2008 landmark Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial, demonstrated an approximately 3-month increase in survival rate in the setting of metastatic HCC [3]. To date, only three published studies have demonstrated complete remission in the setting of advanced or metastatic HCC [4, 5, 6].We present a case of a patient with metastatic HCC who achieved sustained, complete biochemical remission and near-complete radiological remission for 42 months while on sorafenib.