Author(s): Cho W, Kim JM, Choi JY, Lee SH, Moon HH
Hepatocellular carcinoma (HCC) is a common solid tumor. At present, the only curative treatment options for HCC are liver resection and liver transplantation (LT).However, recurrent HCC after LT remains one of the major problems in overcoming this disease. Specifically, the rate of HCC recurrence after LT is approximately10-30% . Surgical resection is the treatment of choice for local recurrence, but this approach is often not possible in many cases due to extrahepatic tumor dissemination. Furthermore, conventional cytotoxic chemotherapy exhibits low efficacy . Sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been shown to have a direct anti-tumorigenic effect and to inhibit cell growth . Likewise, sorafenib, a multiple tyrosine kinase inhibitor, has recently been approved as a first-line treatment for advanced HCC and is recommended by the Barcelona Clinical Liver Cancer (BLCL) staging system . Importantly, sorafenib has been shown to increase survival in advanced cases of HCC . A few studies have assessed the safety and efficacy of concomitant administration of sorafenib and mTOR inhibitors, with results suggesting that a combination therapy approach may have a synergistic effect on HCC. In support of this possibility, combination therapy has been shown to have both anti-proliferative and anti-angiogenic effects . In the present study, we evaluated the safety and efficacy of a combination therapy of sirolimus and sorafenib in patients with HCC recurrence after LT. In addition, we compared the combination therapy with other non-combination treatments according to patient survival.