Chemotherapy (chemo) is treatment with drugs to destroy cancer cells. Chemo may be an option for people whose liver cancer cannot be treated with surgery, has not responded to local therapies such as ablation or embolization, or when targeted therapy is no longer helpful.
Unfortunately, most chemo drugs do not have a great effect on liver cancer. Recent advances have shown that a combination of drugs may be more helpful than using just a single chemo drug. But even these combinations of drugs shrink only a small number of tumors, and the responses often do not last long. And most studies show systemic chemo has not helped patients live longer.
The most common chemotherapy drugs for treating liver cancer include:
Sometimes, combinations of 2 or 3 of these drugs are used. GEMOX (gemcitabine plus oxaliplatin) is one option for people who are fairly healthy and may tolerate more than one drug. 5-FU based chemotherapy, for example with FOLFOX (5-FU, oxaliplatin and leucovorin), is another option for people with bad liver disease.
You can get chemotherapy in different ways.
Drugs are injected right into a vein (IV) or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body, possibly making this treatment useful for cancers that have spread to other parts of the body.
For IV chemo, a slightly larger and sturdier catheter is required in the vein system to administer chemo. They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing. Many different kinds of CVCs are available. The 2 most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
Treatment for advanced liver cancer is based on how well it is working and what side effects you have.
Drugs are put right into an artery that leads to the part of the body with the tumor. This focuses the chemo on the cancer cells in that area. It reduces side effects by limiting the amount of drug reaching the rest of the body. Hepatic artery infusion, or chemo given directly into the hepatic artery, is regional chemotherapy that can be used for liver cancer.
Doctors have studied putting chemo drugs directly into the hepatic artery at a constant rate to see if it might be more effective than systemic chemo. This technique is known as hepatic artery infusion (HAI). It is slightly different from chemoembolization because surgery is needed to put an infusion pump under the skin of the abdomen (belly). The pump is attached to a catheter that connects to the hepatic artery. This is done while the patient is under general anesthesia. The chemo is injected with a needle through the skin into the pump' reservoir and it is released slowly and steadily into the hepatic artery.
The healthy liver cells break down most of the drug before it can reach the rest of the body. This method gets a higher dose of chemo to the tumor than systemic chemo but doesn’t increase side effects. The drugs most commonly used for HAI include floxuridine (FUDR), cisplatin, and oxaliplatin.
HAI may be used for people with very large liver cancers that cannot be removed with surgery or cannot be treated entirely with TACE. This technique may not be useful in all patients because it requires surgery to insert the pump and catheter, an operation that many liver cancer patients may not be able to tolerate.
Early studies have found that HAI is often effective in shrinking tumors, but more research is still needed.
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects include:
These side effects usually don’t last long and go away after treatment is finished. There are often ways to lessen them. For example, drugs can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about drugs to help reduce side effects.
Along with the possible side effects in the list above, some drugs may have their own specific side effects. Ask your health care team what you can expect.
You should report any side effects you notice while getting chemotherapy to your medical team so that you can be treated promptly. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent side effects from getting worse.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Abou-Alfa GK, Jarnigan W, Dika IE, D’Angelica M, Lowery M, Brown K, et al. Ch. 77 - Liver and Bile Duct Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020:1314–1341.
Cho CS, Lubner S, Owen D. Ch. 118 – Metastatic Cancer to the Liver. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019:1957-1969.
Fong Y, Dupey DE, Feng M, Abou-Alfa G. Ch. 57 - Cancer of the Liver. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019:844-864.
Gao S, Zhang PJ, Guo JH, et al. Chemoembolization alone vs combined chemoembolization and hepatic arterial infusion chemotherapy in inoperable hepatocellular carcinoma patients. World J Gastroenterol. 2015;21(36):10443-52.
He MK, Le Y, Li QJ, et al. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer. 2017;36(1):83. Published 2017 Oct 23. doi:10.1186/s40880-017-0251-2.
Mahvi DA and Mahvi DM. Ch. 58 - Liver Metastases. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020:846 - 862.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. V.1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf on March 12, 2019.
Stuart KE. Systemic treatment for advanced hepatocellular carcinoma. UpToDate website. https://www.uptodate.com/contents/systemic-treatment-for-advanced-hepatocellular-carcinoma. Updated January 16, 2019. Accessed March 12, 2019.
Last Revised: April 1, 2019