LAUSR

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the third leading cause of cancer-related death worldwide [1]. The reported annual incidence of HCC is rising in most countries, mostly due to the increasing burden of chronic hepatitis B and hepatitis C virus (HCV), along with the prevalence of other risk factors such as excessive alcohol consumption. Although new HCV therapies have proven effective, they are often expensive and not always universally accessible. Additionally, the increased incidence of nonalcoholic fatty liver disease secondary to obesity and diabetes contribute to new cases of HCC, especially in developed countries such as the USA [2–4]. The Barcelona Clinic Liver Cancer (BCLC) Classification is the gold-standard guideline for managing patients with HCC [5]. Early stages of HCC can be successfully managed with different treatment modalities, including hepatic resection, liver transplantation, and ablative therapies. Intermediate stages can be treated with chemoembolization. Advanced HCC carries a poor prognosis with a mean survival time of 4–6 months. Given that liver metabolism is not altered in patients with Child-Pugh stage A and B liver disease, sorafenib was introduced as a feasible therapeutic option for advanced stage HCC patients deemed ineligible for curative treatment [6]. Since its US Food and DrugAdministration (FDA) approval in December 2005, sorafenib has been used for the treatment of metastatic renal cell carcinoma (RCC) and HCC [7]. Sorafenib is an inhibitor of multiple classes of receptor tyrosine kinases including platelet-derived growth factor receptor (PDGFR) and vascular endothelial growth factor receptor (VEGFR)-2 [8]. These pathways play central roles in cell proliferation and apoptosis, vasculogenesis, and metastasis [9]. By inhibiting these receptor pathways, sorafenib aims to slow tumor growth and delay disease progression. Sorafenib therapy has been shown to slow disease progression by an average of 4.2 months and prolong survival by a mean of 3 months longer than placebo [10]. Most trials on sorafenib have shown a favorable safety profile. The most commonly reported side effects of sorafenib treatment include diarrhea (30%), dermatologic toxicity (rash, hand-foot skin reaction in 30% of patients), hypertension (15%), and hyperlipasemia/hyperamylasemia (30–40% average incidence rate) [11, 12]. Acute pancreatitis is a rare side effect of sorafenib with an incidence rate of <1% and has occurred most commonly in patients being treated for metastatic renal cell carcinoma (Table 1). Most side effects are reported to occur within 3 weeks of initiating treatment [18]. We present the case of a 53-year-old man with HCC who had been taking sorafenib 200 mg twice daily for 3 weeks, but stopped therapy after suffering from a lower extremity rash. Three days after stopping therapy, he suffered from acute pancreatitis. This is the first reported case of a patient suffering from acute pancreatitis secondary to sorafenib treatment that occurred after the patient had already stopped therapy. Due to the increased frequency of sorafenib use among patients with unresectable hepatocellular carcinoma, our purpose was to analyze the literature for reported cases of sorafenib-induced pancreatitis. The goal of our literature review was to determine how many cases have been reported, * Patrick Twohig [email protected]