Oxaliplatin Plus S1 for Treating Sorafenib-Refractory Recurrent Hepatocellular Carcinoma after Liver Transplantation

Recurrent hepatocellular carcinoma (HCC) following liver transplantation (LT) correlates with a poor prognosis due to the lack of effective therapeutic approaches after sorafenib (SORA) or everolimus (EVL) resistance. We assessed the efficacy of SOX (S-1 and oxaplatin) after failed SORA for HCC recurrence after LT based on the results of next generation sequences (NGS). A patient with HCC recurrence after LT was treated with SORA until severe side effect. And then NGS was performed on the primary and metastatic tumor tissues. Investigations on molecular aberrations in cellular pathways and SNPs of drug-related genes were applied. The result of the first NGS shows the benefit from platinum drugs and no abnormalities in PI3K/AKT/mTOR pathway. He received SOX regimen for 4 cycles with progression-free survival (PFS) as long as 4.3 months. NGS of lung and liver metastasis tissues after disease progression still did not match molecular target of everolimus, which he switched to for experimental therapy. He died of failure treatment with 17.3 months overall survival. SOX regimen may benefit recurrent HCC after LT. NGS may provide personalized clinical care for HCC patients.