Because there are only a few effective ways to prevent or treat liver cancer at this time, there is always a great deal of research going on in the area of liver cancer. Scientists are looking for causes and ways to prevent liver cancer, and doctors are working to improve treatments.

Prevention

The most effective way to reduce the worldwide burden of liver cancer is to prevent it from happening in the first place. Some scientists believe that vaccinations and improved treatments for hepatitis could prevent about half of liver cancer cases worldwide. Researchers are studying ways to prevent or treat hepatitis infections before they cause liver cancers. Research into developing a vaccine to prevent hepatitis C is ongoing. Progress is being made in treating chronic hepatitis with drugs that boost the patient's immune system.

Screening

Several new blood tests are being studied to see if they can pick up liver cancer earlier than using AFP and ultrasound. So far, none of these has proved more helpful than what is already being used.

Surgery

Newer techniques are being developed to make both partial hepatectomy and liver transplants safer and more effective.

Adding other treatments to surgery

Doctors are studying ways to make more liver cancers resectable by trying to shrink them before surgery. Studies are now looking at different types of neoadjuvant therapies (therapies given before surgery), including chemotherapy, immunotherapy, embolization, and radiation therapy. Early results have been promising but have only looked at small numbers of patients.

Another active area of research uses adjuvant therapies -- those given right after surgery -- to try to reduce the chances that the cancer will return. Unfortunately, most of the studies using chemotherapy or chemoembolization after surgery have not shown that they help people live longer. Some promising results have been seen with radioembolization, but these need to be confirmed in larger studies.

Laparoscopic surgery

Doctors are also beginning to study a technique called laparoscopic surgery. In this procedure, several small incisions are made in the abdomen, through which specially designed instruments are inserted to view and cut out the diseased portion of the liver. It does not require a large incision in the abdomen, which means there is less blood loss, less pain after surgery, and a quicker recovery. At this time, laparoscopy is still considered an experimental form of treatment for liver cancer. It is being studied mainly in patients with small tumors in certain parts of the liver that can be easily reached through the laparoscope.

Determining recurrence risk after surgery

After a partial hepatectomy, one of the biggest concerns is that the cancer will come back (recur). Knowing someone's risk for recurrence after surgery might give doctors a better idea of how best to follow up with them, and may someday help determine who needs additional treatment to lower this risk.

Researchers may have found a way to do this by testing the cells in the surgery sample. In a recent study, they looked at the pattern of genes in liver cells near the tumor (not the tumor cells themselves) and were able to predict which patients were at higher risk for recurrence. This is an early finding that will need to be confirmed in other studies before it is widely used.

Radiation therapy

The major problem with using radiation therapy against liver cancer is that it also damages healthy liver tissue. Researchers are now working on ways to focus radiation therapy more narrowly on the cancer, sparing the nearby normal liver tissue. Several new approaches to radiation therapy are being tried, including using radiosensitizers (drugs that make cancers more vulnerable to radiation).

Targeted therapy

New drugs are being developed that work differently from standard chemotherapy drugs. These newer drugs target specific parts of cancer cells or their surrounding environments.

Tumor blood vessels are the target of several newer drugs. Liver tumors need new blood vessels to grow beyond a certain size. The drug sorafenib (Nexavar^®), which is already used for some liver cancers that can't be removed surgically, works in part by hindering new blood vessel growth (angiogenesis). Bevacizumab (Avastin^®) also works to block new blood vessel growth. It has shown promising results against liver cancer both alone and in combination with the drug erlotinib (see below).

Other new drugs have different targets. For example, a drug called erlotinib (Tarceva^®), which targets a protein called EGFR on cancer cells, has shown some benefit in people with advanced liver cancer in early studies. Several other targeted drugs are now being studied as well.

Chemotherapy

New forms of systemic and regional chemotherapy combined with other treatments are being tested in clinical trials. A small number of tumors respond to chemotherapy, although it has not yet been shown to prolong survival.

Newer chemotherapy agents, such as oxaliplatin, capecitabine, gemcitabine, and docetaxel, are being tested against liver cancer in clinical trials. The drug oxaliplatin has shown promising results when given in combination with doxorubicin and also when given with gemcitabine and the targeted therapy drug cetuximab (Erbitux^®).

Gene therapy

Scientists are learning more about many of the genes that are damaged when normal liver cells become cancerous. They are hoping to be able to use this information to develop gene therapies to replace these defective DNA sequences.

The p53 gene is a tumor suppressor gene that is often altered in liver cancers. In normal liver cells, it prevents excessive growth, helps cells repair damage to their DNA, and promotes the death of cells when DNA damage becomes too much to be repaired. Restoring normal p53 DNA to liver cancer cells might suppress tumor growth and cause the cancer cells to die. Clinical trials are being done to study the effectiveness of this type of therapy, including possible short and long-term side effects.

Last Medical Review: 11/05/2009
Last Revised: 11/05/2009