Currently, drugs used to treat liver cancer fall into three categories: traditional cytotoxic drugs (chemotherapy, or chemotherapy), targeted drugs, and immunotherapeutic drugs.
Traditional cytotoxic drugs
Traditional cytotoxic agents, including adriamycin, epi-amycin, fluorouracil, cisplatin, and mitomycin, have single-agent efficiencies of less than 20% in hepatocellular carcinoma and are highly toxic and poorly reproducible.
Chemotherapy drugs not only activate hepatitis B virus replication, but also damage patients’ liver function and exacerbate hepatitis cirrhosis, so chemotherapy is not as effective as it could be.
In 2010, China approved oxaliplatin for the treatment of locally advanced and metastatic liver cancer that is not suitable for surgical resection or local treatment, extending the survival of advanced liver cancer to six months.
Targeted drugs
First-line targeted agents for hepatocellular carcinoma include sorafenib and levatinib, with an average overall survival of about 10 to 14 months. After failure of first-line therapy, the second-line option is regorafenib, which has been marketed in China.
- The most common adverse reactions to sorafenib are diarrhea, weight loss, hand-foot syndrome, rash, myocardial ischemia, and hypertension, which typically occur within 2 to 6 weeks of treatment initiation.
- Levatinib (also known as lenvatinib) is recommended for once-daily oral dosing. This drug was launched in China in September 2018.
Immunotherapy drugs
Immunotherapy for hepatocellular carcinoma includes immunomodulators (interferon α, thymidine α1), and immune checkpoint blockers. The latter include cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) blockers, and programmed death-1 (PD-1) and its ligand (PD-L1) inhibitors. These drugs have been shown to inhibit tumor growth and recurrence of metastasis in patients with hepatocellular carcinoma.
Nabumab, a PD-1 inhibitor, has now been approved by the FDA for use in patients with advanced liver cancer who have failed treatment with sorafenib.
In addition, pericyte therapies such as cytokine induced killer cell (CIK) and chimeric antigen receptor T cell immunotherapy (CAR-T) are also in full swing in clinical trials.
It is believed that in the near future, more and more treatment options will be available to better prolong the survival of patients with liver cancer. Therefore, patients are encouraged to participate in clinical trials of new drugs.