A Novel Approach Using Sorafenib in Alpha Fetoprotein-Producing Hepatoid Adenocarcinoma of the Lung

Hepatoid adenocarcinoma of the lung (HAL) is an extremely rare cancer without clear treatment guidance and with a poor prognosis. This report discusses a 64-year-old man who presented with complaints of hemoptysis and was found to have a right upper lobe (RUL) lung mass on chest CT with presence of a right hilar mass and retrocaval lymphadenopathy, and metastasis to the vertebral spine and rib. The patient was diagnosed with T2N2M1 (stage IV) unresectable disease. A biopsy of the RUL mass revealed hepatoid variant adenocarcinoma. Immunohistochemical stains showed tumor cells positive for CK7, AFP, Hep Par 1, napsin A, and cytoplasmic TTF-1 staining. In contrast, CK5, CK6, and CK20 were negative, and EGFR was wild-type. Serum alpha fetoprotein (AFP) level was elevated at 181 ng/mL. The patient was treated with platinum-based doublet chemotherapy and sorafenib, and his AFP level decreased to 25 ng/mL. This case report presents the novel use of sorafenib in combination with platinum-based doublet chemotherapy in EGFR wild-type HAL, which led to a partial response. Single-agent sorafenib led to stable disease overall, achieving a survival among the longest reported for unresectable stage IV, all while maintaining an ECOG performance status of 0 to 1.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe the differential diagnosis of HAL and previously used treatment described in the literature
  • Examine the use of sorafenib in combination with platinum-based doublet chemotherapy in EGFR wild-type HAL
Additional information
Supporters: 

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
04/17/2015
Course expires: 
04/17/2016
Cost:
$0.00

Tatjana Gavrancic, MD
Icahn School of Medicine at Mount Sinai Bronx program
James J.Peters Veterans Affairs Medical Center
New York, New York

Yeun-Hee Anna Park, MD
Icahn School of Medicine at Mount Sinai Bronx program
James J.Peters Veterans Affairs Medical Center
Columbia University
New York, New York

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
04/17/2015
Course expires: 
04/17/2016

Price

Cost:
$0.00
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  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing