Platelet count less than SHARP: what does a case series reveal?

Abstract

Hepatocellular carcinoma (HCC) is increasing in numbers worldwide, and no effective systemic treatment existed for advanced HCC until SHARP (Sorafenib in HCC Assessment Randomized Protocol) study proved sorafenib (Nexavar^®, Bayer Pharmaceuticals, Wayne, NJ, USA) prolonged survival versus placebo. Child-Pugh class A liver function and a platelet count of ≥ 60,000/mm³ were among the inclusion criteria for SHARP. No safety data in patients with < 60,000/mm³ of platelets are present. Thrombocytopenia is one of the most frequent challenges faced in patients with chronic liver diseases. We report a series of three patients with HCC and platelet count < 60,000/mm³ who were successfully treated with sorafenib with no complications. We describe the current data on sorafenib and challenges faced in patients with HCC. In addition, we emphasize the need for informed consent when facing factors that predispose to bleeding (esophageal varices, coagulopathy and thrombocytopenia), possible band ligation before the start of sorafenib, careful clinical monitoring and discontinuation of sorafenib when major bleeding occurs.

Keywords::

• bleeding
• Child-Pugh classification
• hepatocellular carcinoma
• sorafenib
• thrombocytopenia

Notes