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In performing this procedure, the surgeon inserts a tube called a catheter into the hepatic artery and then injects tiny gelatin particles into the artery to block the flow of blood. In some cases, anticancer drugs, such as doxorubicin, mitomicin C, or cisplatin, may also be injected into the hepatic artery along with the gelatin particles. This type of localized cancer treatment is known as chemoembolization and results in very high local concentrations of anticancer drugs at the tumor site for a prolonged period of time. Although hepatic arterial embolization, with or without chemotherapy, is not a curative treatment for liver cancer, it does confer benefits by slowing down the rate of tumor progression and, thereby, prolonging survival. Because patients with poor liver function cannot eliminate (detoxify) the high concentrations of anticancer drugs that are used during chemoembolization, this treatment modality is usually restricted to patients with adequate residual liver function.

Systemic Chemotherapy

Some patients with advanced-stage liver cancer, where the cancer has spread throughout the liver or to other parts of the body, receive systemic chemotherapy with anticancer drugs in an attempt to slow the progression of the disease and prolong survival. Unfortunately, liver cancer does not respond well to most forms of standard systemic chemotherapy. Because many patients with advanced-stage liver cancer also have extensive liver cirrhosis and poor residual liver function, the use of systemic chemotherapy in these patients is even more challenging and problematic.

The anticancer drug that is most widely used as systemic chemotherapy for liver cancer is doxorubicin (Adriamycin). Combination chemotherapy with several different drugs may also be used. Some of the drugs that may be used in combination chemotherapy include doxorubicin, cisplatin, 5-fluorouracil, and tegafur.

In general, most studies have not demonstrated an improvement in survival rates with either single-agent or combination chemotherapy in patients with advanced-stage liver cancer.

In November 2007, the U.S. Food and Drug Administration (FDA) approved a drug called sorafenib (Nexavar) for use in patients with hepatocellular carcinoma when the cancer is inoperable. Sorafenib, which is a member of a class of drugs known as tyrosine kinase inhibitors that was originally approved in 2005 for the treatment of patients with advanced renal cell carcinoma (the most common form of kidney cancer. Sorafenib is formulated as a tablet and is taken by patients orally (by mouth).

The FDA's approval of sorafenib was based on the results of an international randomized, controlled clinical trial involving 602 patients with inoperable hepatocellular carcinoma which showed a statistically significant benefit in terms of survival for patients treated with sorafenib. Patients in the study who received sorafenib survived and average of 10.7 months compared to only 7.9 months for patients who received a placebo. The tumor progression rate among patients who were treated with sorafenib was also slower than for the group of patients who received a placebo.

The most common adverse reactions reported for patients who have been treated with sorafenib are:

• Abdominal pain
• Anorexia
• Diarrhea