• Robert Mahn, Farsaneh Sadeghlar, Alexandra Bartels, Taotao Zhou, Tobias Weismüller, Patrick Kupczyk, Carsten Meyer, Florian C Gaertner, Marieta Toma, Tim Vilz, Petra Knipper, Tim Glowka, Steffen Manekeller, Jörg Kalff, Christian P Strassburg, and Maria A Gonzalez-Carmona.
• Department of Internal Medicine I, University Hospital Bonn, Germany.
• Medicine (Baltimore). 2021 Sep 24; 100 (38): e27082e27082.

RationaleRecurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains a major therapeutic challenge. In recent years, new molecular-targeted therapies, such as cabozantinib, have been approved for the treatment of advanced HCC. However, clinical experience with these new drugs in the treatment of HCC in the LT setting is very limited.Patient ConcernsIn 2003, a 36-year-old woman was referred to the hospital with right upper abdominal pain.DiagnosisAn initial ultrasound of the liver demonstrated a large unclear lesion of the left lobe of the liver. The magnet resonance imaging findings confirmed a multifocal inoperable HCC in a non-cirrhotic liver. Seven years after receiving a living donor LT, pulmonary and intra-hepatic recurrence of the HCC was radiologically diagnosed and histologically confirmed.InterventionsFollowing an interdisciplinary therapy concept consisting of surgical, interventional-radiological (with radiofrequency ablation [RFA]) as well as systemic treatment, the patient achieved a survival of more than 10 years after tumor recurrence. As systemic first line therapy with sorafenib was accompanied by grade 3 to 4 toxicities, such as mucositis, hand-foot skin reaction, diarrhea, liver dysfunction, and hyperthyroidism, it had to be discontinued. After switching to cabozantinib from June 2018 to April 2020, partial remission of all tumor manifestations was achieved. The treatment of the remaining liver metastasis could be completed by RFA. The therapy with cabozantinib was well tolerated, only mild arterial hypertension and grade 1 to 2 mucositis were observed. Liver transplant function was stable during the therapy, no drug interaction with immunosuppressive drugs was observed.OutcomesMore than 10 years survival after recurrence of HCC after living-donor LT due to intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy with cabozantinib in the second line therapy.LessonsIn conclusion, this report highlights the tolerability and effectiveness of cabozantinib for the treatment of HCC recurrence after LT. We show that our patient with a late recurrence of HCC after LT benefitted from intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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