Liver Cancer: Chemotherapy and Targeted Therapy
What are chemotherapy and targeted therapy?
Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.
Targeted therapies are medicines that target specific defects found in cancer cells. They kill cancer cells or stop the cells from growing. They tend to have fewer effects on normal cells. Because of this, they can sometimes be more effective than chemo and may cause fewer side effects.
When might chemotherapy or targeted therapy be used for liver cancer?
Chemo and targeted therapy are medicines that can reach all parts of the body. They are used mainly to treat liver cancers that cannot be treated with surgery or other local treatments. These include cancers that have spread to other parts of the body.
Most liver cancers are not very sensitive to chemo, so targeted therapy is often tried first. Chemo might then be used if targeted therapy is no longer working.
How are chemotherapy and targeted therapy given for liver cancer?
Before treatment starts, you’ll meet with a medical oncologist. This is a doctor who specializes in treating cancer with medicines. These include chemo and targeted therapy. The doctor will discuss your treatment options with you and explain what you might expect.
Depending on the specific chemo medicines you’re taking, you may get them in one of these ways.
The drug is given through a small needle that has been put into a vein. The drug may drip in slowly over several hours, or it may be given more quickly over a few minutes.
Some chemo drugs can be taken as a pill.
Hepatic artery infusion (HAI)
In this approach, the chemo is given right into the hepatic artery. This is usually the main blood vessel that feeds tumors in the liver. The healthy parts of the liver break down the chemo before it can reach other parts of the body. This normally causes fewer side effects, so your healthcare provider may use higher doses of chemo. One drawback of this treatment is that it may require surgery to insert a small tube called a catheter into the hepatic artery. Many people with liver cancer may not be healthy enough for this.
This is similar to HAI. Along with giving the chemo into the hepatic artery, the healthcare provider injects particles to plug up the artery. This cuts off some of the tumor's blood supply. This might help shrink it.
Chemo is often given in an outpatient setting. That means that you get it at a clinic, healthcare provider's office, or hospital, and you can go home after the treatment is given. Less often, you may need to stay in the hospital during treatment. Your healthcare provider will watch you for reactions during your treatments. Chemo treatments may last for a while. So, you may want to take something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.
To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles normally last three or four weeks. Your healthcare provider will discuss your chemotherapy schedule with you.
The main targeted therapy medicine used to treat liver cancer is taken as a pill twice a day. This is a strong medicine that can sometimes have serious side effects.
What chemo and targeted drugs are used to treat liver cancer?
These are some of the chemo drugs that might be used to treat liver cancer:
Two or more of these medicines are often combined as the first treatment. Some people may only receive one medicine. These include people who aren’t healthy enough to get two drugs or people who have already gotten chemo for their esophageal cancer.
The main targeted medicine used to treat liver cancer is sorafenib.
What are common side effects of chemotherapy?
Side effects of chemo are different for everyone. They vary based on the drugs you receive. Below is a list of the some of the most common side effects from chemotherapy. Ask your healthcare provider what side effects to watch for.
If you have hair loss, the hair will often grow back after the treatment stops.
Nausea and vomiting
This side effect can often be controlled with medicines. Ask your healthcare provider about it.
Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.
If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.
Loss of appetite or changes in the way things taste
Talk to your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.
Increased risk of infection
During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it normally does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, sore throat, a new cough, or burning during urination.
Bleeding and bruising more easily
Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well.
You may feel tired while getting chemo. This normally goes away once treatment ends.
Some other side effects can also be seen with certain chemo drugs. For example, cisplatin, carboplatin, and some other drugs can cause nerve damage (neuropathy ). This can lead to pain, tingling, and numbness in your hands and feet.
What are common side effects of targeted therapy?
Sorafenib does not usually cause as many side effects as chemo. Possible side effects include: ,
High blood pressure
Loss of appetite
Skin redness or blistering on your hands or feet
Working with your healthcare provider
It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.
Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?
It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.
March 21, 2017
Systemic Treatment for Advanced Hepatocellular Carcinoma. UpToDate.
Alteri, Rick, MD,LoCicero, Richard, MD