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Liver Cancer: Systemic Therapies

What are systemic therapies?

Systemic therapies are medicines that travel all through the body to kill cancer cells or slow their growth. They may be given right into your blood (as an IV), as a shot, or as pills you take at home.

There are 3 main systemic therapies used to treat liver cancer:

  • Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cells that grow quickly, like cancer cells. But some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

  • Targeted therapy medicines target specific changes in cancer cells. They kill cancer cells or stop the cells from growing. They tend to have fewer effects on normal cells. As a result, they may cause fewer and different side effects than chemo. 

  • Immunotherapy medicines help the immune system find and kill cancer cells.

When might systemic therapies be used for liver cancer? 

Systemic therapies are medicines that can reach all parts of the body. They're 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. But chemo might be used if targeted or immunotherapy is no longer working.

Targeted therapy is often the first treatment used when surgery can't be done or when the cancer has spread to other organs.

Immunotherapy is sometimes part of the main treatment and given along with targeted therapy. It might also be used if targeted therapy stops working.

How are systemic therapies given for liver cancer?

Before treatment starts, you’ll meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines. This provider will discuss your treatment options with you and explain what you might expect.

Chemotherapy 

Depending on which chemo medicines you’re getting, you may get them in 1 of these ways:

  • Intravenous (IV). The medicine goes right into your blood through a small tube (catheter) that's been put into a vein. The medicine may drip in slowly over several hours. Or it may be given more quickly over a few minutes. 

  • Pills. Some chemo medicines can be taken as a pill you swallow.

  • Hepatic artery infusion (HAI). In this approach, the chemo is put 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 treatment tends to cause fewer side effects, so higher doses of chemo can be used. One drawback of this treatment is that surgery may be needed to put a small tube (catheter) into the hepatic artery. Many people with liver cancer aren't healthy enough for this.

  • Chemoembolization. This approach is a lot like HAI. Along with giving the chemo into the hepatic artery, tiny particles are injected to plug up the artery. Doing so cuts off some of the tumor's blood supply and might help shrink it.

Sometimes 2 or more chemo medicines are used together. Chemo is often given as an outpatient treatment. That means that you get it at a clinic, healthcare provider's office, or hospital. 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 1 or more days of treatment, followed by some time to rest. Cycles normally last 3 or 4 weeks. Your healthcare provider will discuss your chemo schedule with you.

Targeted therapy

Targeted therapy medicines for liver cancer are taken as pills at home. They are strong medicines that can sometimes have serious side effects. 

Immunotherapy

These medicines are liquids that are put into your blood through a small tube (catheter) that's been put into a vein. They're given once every few weeks. You may get immunotherapy in your healthcare provider's office or an infusion clinic.

What medicines are used to treat liver cancer?

These are some of the chemo medicines that might be used to treat liver cancer:

  • Capecitabine

  • Cisplatin 

  • Doxorubicin

  • 5-fluorouracil (5-FU)

  • Gemcitabine

  • Oxaliplatin

  • Leucovorin

  • Mitoxantrone

Targeted medicines are the main medicines used to treat liver cancer. Those most often used are sorafenib and lenvatinib. Others that might be used are:

  • Regorafenib

  • Cabozantinib

  • Bevacizumab

  • Ramucirumab

Immunotherapy medicines that might be used for some people with liver cancer include:

  • Atezolizumab

  • Pembrolizumab

  • Nivolumab

  • Ipilimumab

What are common side effects of systemic therapies?

Side effects of these medicines are different for everyone. They vary based on the medicines you get. Below are lists of some of the most common side effects of these treatments. All the treatments can cause less common, but serious side effects, too. Be sure to ask your healthcare provider what side effects you could have and what you should watch for.

Many treatment side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends.

Chemotherapy

  • Hair loss

  • Nausea and vomiting

  • Mouth sores

  • Diarrhea

  • Loss of appetite

  • Changes in the way things taste

  • Low blood cell counts

    • Low white blood cell counts can put you at a high risk for infection.

    • Low red blood counts can cause extreme tiredness (fatigue).

    • Low platelet counts can make you bruise and bleed easily.

Targeted therapy

  • Tiredness (fatigue)

  • High blood pressure

  • Skin rashes

  • Loss of appetite

  • Weight loss

  • Diarrhea

  • Skin redness or blistering on your hands or feet (hand-foot syndrome)

  • Low blood cell counts

Immunotherapy

  • Tiredness (fatigue)

  • Fever

  • Cough

  • Skin rashes

  • Itching

  • Loss of appetite

  • Diarrhea or constipation

  • Muscle pain, joint pain, or both

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, targeted therapy can cause skin changes that 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.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: L Renee Watson MSN RN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 2/1/2021
© 2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare provider's instructions.