Lanreotide treatment of metastatic hepatocellular carcinoma resulting in partial regression and more than 3 years of progression-free survival

We describe the case of a 54 years old woman, with hepatitis B, in whom the diagnosis of a 6 cm hepatocellular carcinoma (HCC) in the left liver was made in 2001. Alpha-foeto-protein (AFP) was 63 ng/mL (Nl < 10 ng/mL). After work-up including liver and tumor biopsy confirming HCC and only fibrosis in the non- tumoral liver, left hepatectomy was performed. Final pathology showed a well differentiated HCC with tumoral portal vein throm- bosis. Unfortunately, lung and mediastinal adenopathies were detected by CT scan 17 months later. Mediastinal nodes were punc- tured by endosonographic ultrasound, confirming HCC. The patient started treatment with Lanreotide 30 mg twice a month (Somatuline PR®, Ipsen). Three months later, CT showed decrease in size of the mediastinal nodes and complete disappearance of the lung nodes. This objective response lasted for 42 months. The treat- ment was without any significant side effect. Retrospectively, immunohistochemistry was performed to detect somatostatine receptors (sstr) 2. Both the primary tumor and the node showed intense membranous and cytoplasmic staining for sstr2. In 2006, AFP rose and CT showed the appearance of a new mediastinal node. At that time, octreoscan® was performed and showed uptake in the new node, although insufficient for metabolic radiotherapy. This case suggests that, although a number of randomized con- trolled trials did not show a benefit of somatostatin analogues in the treatment of advanced HCC, a subset of patients could benefit from treatment provided their tumor expresses sstr2, on which the existing drugs are efficient. (Acta gastroenterol. belg., 2012, 75, 270- 273).