New Treatments in Advanced Liver Cancer
Hepatocellular carcinoma (HCC) is the most frequent type of liver cancer worldwide (Nature Reviews Gastroenterology & Hepatology, 2019). Usually, it occurs with chronic liver disease and cirrhosis. Prevalence of hepatitis B and C are major risk factors in China, while nonalcoholic fatty liver disease caused by obesity is the leading cause in the United States (Medscape, 2020). HCC is more common in China than other countries. Annually, over 756,000 HCC cases are diagnosed worldwide, and more than 353,000 are diagnosed in China (Roche, 2020). The most preferred treatment for early-stage liver cancer is surgery, which includes partial hepatectomy (partial removal of liver), otherwise the patient would be evaluated for liver transplantation. Another option is locoregional therapy, such as percutaneous ablation, which is a procedure that utilizes radio waves or microwaves to destroy the cancer. However, systemic treatment involving drug therapies is commonly utilized in advanced liver cancer (American Cancer Society, 2019). This article will focus on medication therapies in patients who are not surgical or transplant candidates.
Therapies recommended by National Comprehensive Cancer Network (NCCN) to use first in advanced liver cancer are Nexavar® (sorafenib), Lenvima® (lenvatinib), or atezolizumab plus bevacizumab (NCCN, 2020). Nexavar® and Lenvima® are a type of targeted therapy called kinase inhibitors. Targeted therapy, which attacks specific genes or proteins that help cancer cells grow, is one of the major focuses in research to treat cancer (American Society of Clinical Oncology, 2020). Nexavar® had been the only targeted therapy to treat HCC for many years. In the last three years, however, several existing targeted therapies have been approved to treat liver cancer, including: Stivarga® (regorafenib) and Cabometyx® (cabozantinib) (National Cancer Institute, 2020). These medications are approved to be used in liver cancer patients who have been previously treated with Nexavar® (Stivarga® FDA Label, 2017; Cabometyx® FDA Label, 2019).
Atezolizumab plus bevacizumab is another first-line therapy in liver cancer. It was approved by FDA in May 2020 (FDA, 2020). Bevacizumab belongs to a class called monoclonal antibody. It slows the growth of cancer by preventing blood vessel formation (American Cancer Society, 2020). This drug is used with the immunotherapy medication atezolizumab, which works by stimulating the immune system to kill cancer cells (NCCN, 2020). A global clinical trial has shown a one-year overall survival of 67.2% with atezolizumab plus bevacizumab and 54.6% with Nexavar® (N Engl J Med, 2020). Another new immunotherapy approved in March 2020 to treat advanced liver cancer is Opdivo® (nivolumab). It is approved to be used in liver cancer patients who have been previously treated with Nexavar® (FDA Label Opdivo®, 2020).
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