A 60-year-old male patient presented to OPD with right upper quadrant abdominal pain, jaundice, fever with a significant history of weight loss, loss of appetite and lethargy. On examination a mass was palpable in the right hypochondrium which was firm in consistency and about 5×5 cm on palpation along with severe hepatomegaly. On seeing the previous records, patient was found to be a known case of Hepatitis C and was on medication for the same. Lab studies, Raised AFP levels Hypercalcemia Erythrocytosis No cirrhotic changes were evident on USG abdomen. Triple phase CT, Liver biopsy were performed. . Which of the following drug has been approved for the above condition: – Sorafenib Imatinib Dasatinib Regorafenib Ramucirumab
A 60-year-old male patient presented to OPD with right upper quadrant abdominal pain, jaundice, fever with a significant history of weight loss, loss of appetite and lethargy. On examination a mass was palpable in the right hypochondrium which was firm in consistency and about 5×5 cm on palpation along with severe hepatomegaly. On seeing the previous records, patient was found to be a known case of Hepatitis C and was on medication for the same. Lab studies, Raised AFP levels Hypercalcemia Erythrocytosis No cirrhotic changes were evident on USG abdomen. Triple phase CT, Liver biopsy were performed. . Which of the following drug has been approved for the above condition: – Sorafenib Imatinib Dasatinib Regorafenib Ramucirumab
π‘ Explanation
**Core Concept**
The patient's presentation of right upper quadrant abdominal pain, jaundice, fever, weight loss, and a palpable mass in the liver, along with a history of Hepatitis C, suggests the development of hepatocellular carcinoma (HCC). The absence of cirrhotic changes and the presence of raised alpha-fetoprotein (AFP) levels support this diagnosis.
**Why the Correct Answer is Right**
Sorafenib is a multikinase inhibitor that has been approved for the treatment of advanced hepatocellular carcinoma (HCC). It works by inhibiting the activity of several kinases involved in tumor growth and angiogenesis, including RAF, VEGFR, and PDGFR. The use of sorafenib in this patient is likely due to the progression of HCC despite previous treatment for Hepatitis C.
**Why Each Wrong Option is Incorrect**
**Option A:** Imatinib is a tyrosine kinase inhibitor primarily used in the treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GISTs). It is not approved for the treatment of HCC.
**Option B:** Dasatinib is another tyrosine kinase inhibitor used in the treatment of CML and acute lymphoblastic leukemia (ALL). It is not approved for HCC treatment.
**Option C:** Regorafenib is a multikinase inhibitor similar to sorafenib, but it is primarily used in the treatment of metastatic colorectal cancer (mCRC) and gastrointestinal stromal tumors (GISTs). While it can be used for HCC, it is not the most appropriate choice in this scenario.
**Option D:** Ramucirumab is a monoclonal antibody that targets the VEGF receptor, inhibiting angiogenesis. It is used in the treatment of advanced gastric cancer and non-small cell lung cancer (NSCLC), but not HCC.
**Clinical Pearl / High-Yield Fact**
The use of sorafenib in HCC is a classic example of targeted therapy, where a drug is designed to inhibit specific molecular pathways involved in tumor growth and progression. This approach has revolutionized the treatment of various cancers, including HCC.
**Correct Answer:** C. Regorafenib
β Correct Answer: D. 1, 4 and 5
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