Febrile Neutropenia after Sunitinib in Patient with Advanced Hepatocellular Carcinoma

Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, has been demonstrated effective in the treatment of advanced hepatocellular carcinoma (HCC). Use of the drug has been reported with 11% incidence of neutropenia which usually does not require a medical intervention. Patients with neutropenia-associated infections have a poor prognosis. Febrile neutropenia represents the most life-threatening hematologic complication and invariably should prompt treatment interruption. Here, we report a case of advanced HCC who suffered from febrile neutropenia after using sunitinib for two weeks. Because of limited treatment options and poor response rates of conventional therapies for advanced HCC, sunitinib has been developed as a new therapy. Sunitinib exhibits the side effect of neutropenia, which requires monitoring white blood counts and aggressive management when febrile neutropenia has occurred. In advanced HCC, the side effects and complication after TACE and ablation majorly range from fever and upper abdominal pain for liver abscess and acute or chronic liver failure. The comprehension of such an unpredictable sunitinib-associated febrile neutropenia will surely profit from more clinical case reports. Thus, the incidence of sunitinib-associated febrile neutropenia may increase in the future. Clinicians should be aware that febrile neutropenia might occur at any time during the treatment with this drug, even with normal white blood count and platelet count initially. Consequently, monitoring of complete blood count is mandatory during treatment in order to avoid sepsis and unfavorable clinical outcomes.