Sequential Regorafenib or Nivolumab Therapy in Recurrent Hepatocellular Carcinoma with Sorafenib Failure in Liver Transplant Patients Does Not Improve Prognosis

Background: Systemic treatment options for hepatocellular carcinoma (HCC) after liver transplantation (LT) are limited in patients in whom sorafenib treatment was failed. The purpose of our study was to compare outcomes among sorafenib, regorafenib, and nivolumab treatment groups in patients with recurrent HCC after LT. Methods: This study retrospectively evaluated patients who received sorafenib for recurrent HCC treatment after LT at a single center from March 2007 to December 2018. Some patients received regorafenib or nivolumab after sorafenib treatment failure. Results: Fifty-six patients were treated with sorafenib due to HCC recurrence. Among these, 38 patients (67.9%) continued treatment with sorafenib only; the other 18 patients (32.1%) were converted to regorafenib treatment. Ten patients (17.9%) of these 18 were converted to nivolumab after sorafenib and regorafenib therapy failed. The disease-free survival and overall survival (OS) from LT were not different among the three groups. In addition, OS from HCC recurrence, sorafenib usage, and usage of each systemic therapeutic agent were not different among the three groups. Three cases in the nivolumab group developed acute rejection; one of these led to graft failure and death due to antibody-mediated rejection. Conclusion: Sequential regorafenib or nivolumab treatment in recurrent HCC LT patients does not improve OS compared sorafenib treatment.