TAIPEI VETERANS GENERAL HOSPITAL

CTC-Guided EGFR Inhibitor Therapy Achieves 14-Month Response in Metastatic Hepatocellular Carcinoma

- A 52-year-old woman with metastatic hepatocellular carcinoma showed circulating tumor cells with EGFR mutations (exon 19 deletion and L858R), leading to targeted therapy selection. - EGFR tyrosine kinase inhibitors including erlotinib, afatinib, and osimertinib achieved partial response in lung metastases with treatment benefit lasting 14 months. - The case demonstrates potential for CTC molecular profiling to guide personalized treatment in HCC, where traditional tissue biopsy is often limited by bleeding risk. - EGFR upregulation occurs in approximately 66% of HCC cases, but canonical sensitizing mutations are rare, making CTC analysis particularly valuable for treatment selection.