Immunotherapy Treatment for Advanced Liver Cancer
Immuno-oncology (or immunotherapy) and precision medicine are the newest developments in the treatment of advanced cancer. Immuno-oncology helps to restore the body’s immune system and improves outcomes when administered alone or in combination with chemotherapy.
Immunotherapy is class of treatments that take advantage of a person’s own immune system to help kill cancer cells. There are currently several FDA-approved immunotherapy options for the treatment of liver cancer.
Because standard chemo is not very effective in most patients with liver cancer, doctors are focusing more on using targeted therapies.
Kinase inhibitors: Kinases are proteins on or near the surface of a cell that carry important signals to the cell’s control center. Many of the targeted drugs used to treat liver cancer are kinase inhibitors.
Sorafenib (Nexavar) and lenvatinib (Lenvima): One of these drugs can be used as the first treatment for liver cancer if it cannot be treated by surgery or if it has spread to other organs. Sorafenib is a pill taken twice daily. Lenvatinib is a pill that is taken once a day. Sorafenib may work better in people with liver cancer caused by hepatitis C.
Regorafenib (Stivarga) and cabozantinib (Cabometyx): These drugs can be used to treat advanced liver cancer, typically if other treatments are no longer helpful. Regorafenib is a pill, typically taken once a day for 3 weeks, followed by a week off. Cabozantinib is a pill taken once a day.
Monoclonal antibodies are man-made versions of immune system proteins (antibodies) that are designed to attach to a specific target. The monoclonal antibodies used to treat liver cancer affect a tumor’s ability to form new blood vessels, which it needs to grow beyond a certain size. This new blood vessel growth is called angiogenesis, so these drugs are often referred to angiogenesis inhibitors.
Bevacizumab (Avastin): Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form. This drug can be used along with the immunotherapy drug atezolizumab (Tecentriq) as the first treatment for liver cancer that cannot be treated by surgery or that has spread to other organs. This drug is given as an infusion into a vein (IV), typically once every 3 weeks.
Ramucirumab (Cyramza) Ramucirumab is a monoclonal antibody that targets a VEGF receptor (VEGFR) protein on cells, which can help stop the formation of new blood vessels. This drug can be used to treat advanced liver cancer, typically after another treatment stops working. This drug is given as an infusion into a vein (IV), usually once every 2 weeks.
The goal of immunotherapy is to help the immune system recognize and eliminate cancer cells by either activating the immune system directly, or by inhibiting mechanisms of suppression of the cancer.
In an attempt to improve the chance of cure, immunotherapies are being tested alone or in combination with chemotherapy in clinical trials.