Treatment
If you or a loved one is affected by liver cancer, it is important to know that there may be a team of doctors who will work with you to determine a treatment plan. Physician specialties might include:
- Hepatologist/Gastroenterologist that specializes in liver disease
- Interventional radiologist
- Medical oncologist
- Surgeon (transplant surgeon and/or surgical oncologist)
Treatment choices depend on the type and stage of the cancer, how well the liver is functioning and the overall health of the individual.
- If the cancer has not spread outside the liver, surgery to remove the tumor or a liver transplant may be considered.2,9
- For more advanced cancers, there are several treatment procedures (see Locoregional Options) that directly damage the liver tumor(s).2,9
- There is also a recently approved oral treatment (see Systemic Therapy) that slows the progression of the cancer.
Surgery
Surgery is the treatment of choice for primary liver cancer. Removing the part of the liver containing the tumor may result in a cure and long-term survival.2
- Surgical resection (removal): It may be possible to remove the tumor(s) and the surrounding tissues in the liver if the tumor is small and in one lobe.2
- If the patient has cirrhosis, but still has well-preserved liver function, then resection remains an option.
- However, many patients are not eligible for resection.2
- Liver transplant: In patients with small tumors and advanced cirrhosis the treatment of choice is liver transplantation.2
Locoregional Treatment Options2, 9
If the cancer has not spread, but the patient is not well enough to have surgery, procedures that damage or kill the tumor in the liver can be used.
- Percutaneous ethanol injection (PEI) can be a useful treatment option in those patients who cannot undergo surgery. This technique is performed under ultrasound guidance. It consists of an injection of alcohol or other substances into the liver, which results in destruction of the tumor.
- Radiofrequency ablation (RFA) is the use of high frequency electrical currents to destroy tumor cells. A probe is inserted into or next to a tumor mass and heat from the probe kills the cancer cells in the tumor mass.
- Cryosurgery is the use of subzero temperatures to freeze the tumor. Liquid nitrogen is injected directly into the tumor under ultrasound guidance. The tumor is frozen and thawed twice. The procedure can be performed alone or in conjunction with a liver resection.
- Transarterial chemoembolization (TACE) is a procedure in which the blood supply to the tumor is blocked and anticancer drugs are administered directly into the tumor. It allows a higher concentration of drugs to be in contact with the tumor for a longer period of time.
Systemic Therapy
Systemic therapy refers to treatment that affects the whole body. In recent years, newer targeted therapies have been developed that target certain protein messengers (kinases) that play a part in the growth and spread of cancer cells and tumors. Research has shown that some kinase signaling pathways inside cancer cells cause them to keep dividing in an uncontrolled fashion causing cancer cells to become tumors. Other important kinase signaling pathways within the surrounding tumor create new blood vessels (neoangiogenesis) which bring the tumor oxygen and nutrients. Therefore these are also important targets to stop the progression and spread of cancer.21, 22
- Nexavar® (sorafenib) tablets is an oral targeted therapy that has been approved in more than 80 countries to treat patients with HCC. It is the first and only oral treatment for HCC, and has been demonstrated to extend the survival of patients whose tumors cannot be surgically removed, known as unresectable HCC.
By slowing tumor growth and reducing the blood supply of the tumor, targeted therapy may prevent the growth and spread of cancer. These processes can also be important to normal cells, so targeted therapies may affect some normal cells as well.
To learn more about this treatment option, visit www.Nexavar.com
Click here for patient prescribing information.
INDICATIONS & USAGE
NEXAVAR is an anticancer medicine used to treat a certain type of liver cancer called hepatocellular carcinoma (HCC), when it cannot be treated with surgery.
IMPORTANT SAFETY INFORMATION
NEXAVAR may cause birth defects or death of an unborn baby. Avoid becoming pregnant while taking NEXAVAR and for at least 2 weeks after stopping your treatment. Men and women should use birth control during and at least 2 weeks after NEXAVAR therapy. Call your doctor right away if you become pregnant. Do not breastfeed while taking NEXAVAR as this medication may be passed through breast milk.
Before starting NEXAVAR, tell your doctor if you have: allergies; heart problems or chest pain; bleeding or bruising problems; high blood pressure; or kidney or liver problems. NEXAVAR may interact with certain other medicines so tell your doctor about all medicines you take including prescription and over-the-counter (OTC) medicines, vitamins, or herbal supplements. It is especially important to tell your doctor if you take warfarin (Coumadin).
NEXAVAR may cause serious side effects, including:
-decreased blood flow to the heart and heart attack. Get emergency help if you have chest pain, shortness of breath, feel lightheaded or faint, have nausea or vomiting, or you are sweating a lot.
-bleeding problems. Tell your doctor if you have any bleeding or easy bruising while taking NEXAVAR.
-high blood pressure. Your blood pressure should be checked every week during the first 6 weeks of starting therapy and then regularly, thereafter. If your blood pressure is high, it may need to be treated.
-a skin problem called hand-foot skin reaction. This causes redness, pain, swelling or blisters on the palms of your hands and soles of your feet. Your doctor may change your dose or stop treatment for a while.
-perforation of the bowel. Tell your doctor right away if you get high fever, nausea, vomiting or abdominal pain.
-wound healing problems. If you have a surgical or dental procedure, tell your doctor you are taking NEXAVAR. Your treatment may be stopped until after your surgery or until your wound heals.
Other side effects with NEXAVAR can include: rash, redness, itching or peeling skin; hair thinning or loss; diarrhea; nausea/vomiting; mouth sores; weakness; loss of appetite; numbness, tingling or pain in hands and feet; abdominal pain; tiredness; or weight loss. Tell your doctor if you have any side effects that bother you or do not go away.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
For important risk and use information, please see the patient prescribing information.
