Purpose: When hepatocellular carcinoma is treated with sorafenib, achieving a complete response and rapid response is rare. Complete response after initial relapse is even more rare. A man aged 57 years with hepatocellular carcinoma, hepatitis B, and cirrhosis was treated with sorafenib and went into complete biochemical and radiographic remission. This was followed by relapse after 5 months, but he, again, achieved complete remission after another 5 months. His clinical course was followed, and temporal association of sorafenib remission with use of clopidogrel was observed. Proposed mechanisms of action and a concise literature review are included.
Results: Our patient was ineligible for invasive treatment modalities, such as resection due to a recent myocardial infarction, and was referred for sorafenib chemotherapy. He had low platelet counts, hence, his placement on a reduced sorafenib dosage. His initial diagnosis of hepatocellular carcinoma rapidly improved with sorafenib, and he achieved a complete biochemical and radiographic response within 7 months. Remission lasted only 5 months, but we noted that the timing of his relapse was right after he incidentally discontinued clopidogrel. It was restarted at the same dose, and within 5 months of restarting clopidogrel, he achieved a second complete remission. Baby aspirin was continuously used throughout his clinical course.
Conclusions: There is possible synergy between VEGF-directed targeted therapy such as sorafenib and antiplatelet therapy specifically P2Y12 inhibitor clopidogrel and aspirin in the treatment of hepatocellular carcinoma. This merits further corroboration.
