The effect of apatinib in the treatment of sorafenib resistant metastatic hepatocellular carcinoma

RATIONALE: Most patients with hepatocellular carcinoma (HCC) have lost the chance of radical treatment at the time of their visit, and the prognosis of metastatic HCC is even worse. Sorafenib is currently regarded as a first-line systemic therapy in patients with advanced and metastatic HCC. Apatinib is a new inhibitor of vascular endothelial growth factor receptor 2 tyrosine kinase, which has been reported to be effective in some solid tumors. We herein report a case of apatinib in the treatment of the patient with metastatic HCC who was resistant to sorafenib. PATIENT CONCERNS: A 41-year-old Chinese man with a history of chronic hepatitis B had undergone an emergency partial hepatectomy for tumor ruptured. Despite the treatment with transcatheter arterial chemoembolization and sorafenib, the progression of tumor failed to control. DIAGNOSES: Although the patient had been treated with sorafenib (400 mg, twice daily) for 10 months, computed tomography documented radiological progression. INTERVENTIONS: Due to disease progression, failure of sorafenib and positive expression of vascular endothelial growth factor (VEGF), the drug regimen was changed to apatinib 250 mg once daily. Due to some degree of resistance, the dose was increased up to 425 mg once daily. OUTCOMES: The patient had a disease-free progression of 7 months at 250 mg apatinib. The dosage was adjusted to 425 mg due to drug resistance and the side effects were tolerable. The patient has survived a total of 19 months under apatinib. LESSONS: Apatinib may be a substitute for the HCC patients with sorafenib resistance in the future, especially for those with high expression of VEGF.