Spontaneous Regression Of Hepatocellular Carcinoma With Reduction In Angiogenesis-related Cytokines After Treatment With Sodium-glucose Cotransporter 2 Inhibitor In A Cirrhotic Patient With Diabetes Mellitus
Kawaguchi, T., Nakano, D., Okamura, S., Shimose, S., Hayakawa, M., Niizeki, T., Koga, H., & Torimura, T. (2019). Spontaneous regression of hepatocellular carcinoma with reduction in angiogenesis-related cytokines after treatment with sodium-glucose cotransporter 2 inhibitor in a cirrhotic patient with diabetes mellitus. Hepatology research : the official journal of the Japan Society of Hepatology, 49(4), 479–486. https://doi.org/10.1111/hepr.13247
View Original Source →Abstract
Spontaneous regression of hepatocellular carcinoma (HCC) is a rare event, and the pathogenesis remains unclear. Here, we present a case of spontaneous regression of HCC after treatment with sodium-glucose cotransporter 2 inhibitor (SGLT2i) in a cirrhotic patient with diabetes mellitus (DM). A 68-year-old man regularly visited our hospital for follow-up of HCC after treatment with transcatheter arterial chemoembolization, and management of liver cirrhosis and type 2 DM. Contrast-enhanced computed tomography scan showed a hypervascular tumor in the liver and elevated serum α-fetoprotein levels, indicating the recurrence of HCC. Simultaneously, the hemoglobin A1c value increased to 8.0%; therefore, he was treated with SGLT2i (canagliflozin 100 mg/day). Ten weeks after the initiation of SGLT2i treatment, he was admitted to our hospital for treatment of recurrent HCC. However, the hypervascular tumor had disappeared, and the elevated serum α-fetoprotein level had decreased to normal limits, indicating spontaneous regression of HCC. In addition, an angiogenesis array analysis revealed downregulated protein expression of matrix metalloproteinase-8, angiopoietin-1/2, platelet-derived growth factor-AA, and prolactin at 10 weeks after SGLT2i treatment. In this report, we first describe a case of spontaneous regression of HCC with reduction in angiogenesis-related cytokines after SGLT2i treatment.
Case Details
Disease Location
Liver
Personal Characteristics
A 56-year-old (at first presentation) japanese man. History of hepatitis c virus (HCV)-related liver cirrhosis and type 2 dm (750 mg/day of metformin and 1 mg/day of glimepiride).
Clinical Characteristics
At the age of 61 and 64, the patient was diagnosed with hcc and was treated with radiofrequency ablation. HCV genotype 2-related liver cirrhosis was managed with sofosbuvir and ribavirin for 12 weeks, and sustained virologic response was achieved at the age of 65. Hcc recurred when the patient was aged 67 years in the s3 segment of the liver. He was treated by transcatheter arterial chemoembolization (tace). 14 weeks after tace, the disease recurred. Sglt2i (canagliflozin 100 mg/day) was administered.
Remission Characteristics
Ten weeks since the initiation of sglt2i treatment, angiography of the hepatic artery revealed no tumor staining. Tumor staining was also not seen in angiography of the collateral arteries. Furthermore, in contrast-enhanced computed tomography scan, the arterial phase hyperenhancement of the contrast agent within the mass disappeared. Moreover, blood biochemical examination showed that the elevated serum AFP level decreased within normal limits, indicating spontaneous regression of hcc
Treatment & Mechanisms
Proposed Remission Mechanisms
Since insulin resistance is a potent risk factor for hcc proliferation 13, sglt2i may suppress hcc through an improvement of insulin resistance.
Clinical Treatment
Tace, sglt2i