What's New in Liver Cancer Research and Treatment?
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.
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 also being made in treating chronic hepatitis.
Several new blood tests are being studied to see if they can detect liver cancer earlier than using AFP and ultrasound. One that is promising is called DKK1.
Newer techniques are being developed to make both partial hepatectomy and liver transplants safer and more effective.
Adding other treatments to surgery
An active area of research uses adjuvant therapies – treatments given right after surgery – to try to reduce the chances that the cancer will return. Most of the studies so far using chemotherapy or chemoembolization after surgery have not shown that they help people live longer. Research studies are also looking into newer drugs, like targeted therapy and may prove to be more effective. Some promising results have also been seen with radioembolization, but these need to be confirmed in larger studies. Another area of study has been the use of anti-viral therapy in people with liver cancer related to having viral hepatitis to see if it improves outcomes after surgery.
Doctors are also 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 targeted therapy, chemotherapy, ablation, embolization, and radiation therapy. Early results have been promising but have only looked at small numbers of patients.
In laparoscopic surgery, several small incisions are made in the abdomen, and special long, thin surgical 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, laparoscopic surgery is still considered experimental 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 might 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.
Various researchers are studying ways to predict if the cancer may come back by testing the liver cells in the surgery sample through genetic profiling. . These studies are promising but will need to be confirmed in other larger studies before it is widely used.
Only a small portion of patients with liver cancer are candidates for a liver transplant because of the strict criteria they need to meet (based mainly on the size and number of tumors). Some doctors are now looking to see if these criteria can be expanded, so that people who are otherwise healthy but have slightly larger tumors might also be eligible.
The main 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. One approach being studied is called brachytherapy. In this treatment, catheters (thin tubes) are placed in the tumor and then pellets that give off radiation are put into the catheters for a short time. After the treatment, both the pellets and the catheters are removed. This allows radiation to be targeted to the cancer with less harm to the normal liver.
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. This drug is now being studied for use earlier in the course of the disease, such as after surgery or trans-arterial chemoembolization (TACE). Researchers are also studying whether combining it with chemotherapy may make it more effective.
Regorafenib (Stivarga®) is another targeted drug that is showing promise in treating liver cancers It is being studied in patients who have not responded to sorafenib. Cabozantinib is another small molecule inhibitor that has been shown to reduce tumor growth and stop new blood vessel growth
New forms of 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.
Chemotherapy drugs, such as oxaliplatin, capecitabine, gemcitabine, and docetaxel, are being tested against liver cancer in clinical trials. Oxaliplatin has shown promising results in early studies when given in combination with doxorubicin and also when given with gemcitabine and the targeted therapy drug cetuximab (Erbitux®).
A newer approach to treatment is the use of a virus, known as JX-594. This started as the same virus that was used to make the smallpox vaccine, but it has been altered in the lab so that it mainly infects cancer cells and not normal cells. A solution containing the virus is injected into liver cancers, and the virus can enter the cancer cells, where it causes them to die or to make proteins that result in them being attacked by the body’s immune system. Early results of this treatment against advanced liver cancer have been promising, even in patients who have already had other treatments.
Last Medical Review: March 31, 2016 Last Revised: April 28, 2016