Metronomic chemotherapy with cyclophosphamide for the treatment of advanced hepatocellular cancer: A case report.

INTRODUCTION AND IMPORTANCE: Metronomic chemotherapy entails chronic, equally spaced administration of low doses of various chemotherapeutic drugs without extended rest periods. Its use as a second-line treatment in advanced or metastatic hepatocellular cancer remains under investigation. CASE PRESENTATION: We report a case of a 49-year-old Caucasian female patient with an enlarged (∼14 cm) hepatocellular cancer. In July 2016, she underwent right hepatectomy (after preceding TACE). During the follow-up period, she presented early disease recurrence with lung and peritoneal metastasis. Initially, she received an inhibitor of protein kinase (sorafenib) for six months without response. Afterwards, cyclophosphamide administration at low doses as metronomic chemotherapy provided complete regression of the metastatic lesions. The patient remains in good performance status almost 4 years after initial treatment, without signs of recurrence in her recent follow-up. CLINICAL DISCUSSION: Using cyclophosphamide as metronomic chemotherapy in advanced hepatocellular cancer may have a promising antiangiogenic antitumor effect. Future clinical trials need to demonstrate this effect in terms of tumor suppression and increased disease-free survival. CONCLUSION: Large multi-centered clinical trials have to be planned to investigate the precise role of cyclophosphamide in the therapy of hepatocellular cancer while defining the patients' profile that will benefit most from cyclophosphamide.