Resources for coping with cancer during the COVID-19 pandemic.
Research in liver cancer
We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better ways to treat liver cancer. The following is a selection of research showing promise for treating liver cancer.
We’ve included information from the following sources. Each item has an identity number that links to a brief overview (abstract).
- PubMed, US National Library of Medicine (PMID)
- American Society of Clinical Oncology (ASCO)
- Canadian Cancer Trials and ClinicalTrials.gov (NCT)
Researchers are looking for the best ways to treat liver cancer using surgery and improve how surgery is done.
A laparoscopic liver resection is when the surgeon makes small cuts (incisions) in the abdomen and then inserts an endoscope and other tools to remove the part of the liver with cancer. In a study, a group of people with one cancerous liver tumour and cirrhosis were assigned to receive either an open liver resection (through a large cut in the abdomen) or a laparoscopic liver resection. The people who had a laparoscopic liver resection had a shorter hospital stay and similar disease-free survival and complications compared to those who had an open liver resection (Journal of Laparoendoscopic & Advanced Surgical Techniques, PMID 29172949).
Find out more about research in cancer surgery.
The most common ablation therapy used for liver cancer is radiofrequency ablation (RFA). Researchers are studying other types of ablation therapy to treat liver cancer.
Microwave ablation uses heat made from microwaves to destroy cancer cells (called hyperthermia treatment). The heat is delivered by a needle placed through the skin and into a tumour. Research shows that microwave ablation may help improve survival in people with hepatocellular carcinoma (ClinicalTrials.gov, NCT 02859753; Clinical Radiology, PMID 27890422).
Irreversible electroporation (IRE) uses a needle that delivers electrical energy directly to the tumour. It has the advantage of killing cancer cells without creating extreme heat or cold. Studies show that IRE seems to be a safe treatment for small liver tumours and that it controls the growth of tumours (European Journal of Surgical Oncology, PMID 28109674).
Find out more about research in hyperthermia treatments.
The standard targeted therapy drug used for advanced liver cancer is sorafenib (Nexavar). Researchers are studying other targeted therapy drugs to treat liver cancer.
Ramucirumab (Cyramza) was studied in the REACH trial, which looked at how it worked in people with advanced liver cancer after they had sorafenib. Ramucirumab improved survival in people who had a higher alpha-fetoprotein (AFP) level than normal (European Journal of Cancer, PMID 28591675;ASCO, Abstract TPS538; CanadianCancerTrials.ca, NCT 02435433).
Regorafenib (Stivarga) may be a treatment option for people with hepatocellular carcinoma if sorafenib stops working and the cancer continues to grow and spread (progresses). An international phase 3 clinical trial showed regorafenib helps prolong survival. More research is needed to see if regorafenib can be combined with other treatments (Lancet, PMID 27932229).
Cabozantinib (Cabometyx) is a tyrosine kinase inhibitor. Researchers are studying it in people with advanced liver cancer. A phase 3 trial shows that cabozantinib improves survival compared to placebo (New England Journal of Medicine, PMID 29972759; ASCO, Abstract 4019).
Apatinib is also a tyrosine kinase inhibitor. Research shows that people treated with apatinib had longer progression-free survival and overall survival (OncoTargets and Therapy, PMID 30288047). One small study found that transarterial chemoembolization (TACE) combined with apatinib works better than TACE alone (Cancer Biology & Therapy, PMID 28548587).
Find out more about research in targeted therapy.
The following is noteworthy research into radiation therapy for liver cancer.
Radioembolization (also called selective internal radiation therapy) gives radiation directly to tumours using tiny radioactive beads (called microspheres). Using a catheter, these beads are placed inside the blood vessels that feed a tumour, delivering a high dose of radiation to the tumour and blocking the supply of blood to the cancer cells. Researchers are trying to find out if radioembolization with yttrium-90 microspheres is better than standard treatment with sorafenib for locally advanced hepatocellular carcinoma. Research is still going on, but some results show that radioembolization does not lead to a longer overall survival than sorafenib (Journal of Clinical Oncology, PMID 29498924; The Lancet Oncology, PMID 29107679; BMC Cancer, PMID 27821083). Other studies report that radioembolization seems to have less serious side effects and better overall survival than chemoembolization (Cancer Biology and Medicine, PMID 30197797). Researchers are still studying the role of radioembolization for liver cancer.
Stereotactic body radiation therapy (SBRT) delivers precisely targeted high doses of radiation to tumours in fewer sessions (fractions). It creates many beams of radiation from different angles that meet at the tumour. The tumour receives a high dose of radiation, while the surrounding tissue gets less radiation from the individual beams. This lowers the effects of radiation on healthy tissue near the tumour. A phase 3 clinical trial is studying how well SBRT and sorafenib work to treat liver cancer compared to sorafenib alone. Combining these 2 treatments may kill more cancer cells (CanadianCancerTrials.ca, NCT 01730937).
Find out more about research in radiation therapy.
Researchers are combining transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and sorafenib with other treatments to see if they improve treatment response and survival in people with liver cancer.
Sorafenib combined with DEB-TACE has been studied in clinical trials for people with liver cancer. DEB stands for drug-eluting beads, which are injected into the hepatic artery. Results of one trial show that this treatment combination improved survival in people with advanced liver cancer (Radiology, PMID 26069923). But other trials have not shown the same benefit of this combination (The Lancet Gastroenterology & Hepatology, PMID 28648803; Journal of Hepatology, PMID 26809111).
TACE with RFA has been studied as a treatment for early hepatocellular carcinoma instead of having liver resection surgery. A review of many studies (called a systematic review) shows that surgery has better survival and a lower chance of the cancer coming back (recurrence rate) than TACE plus RFA (The American Surgeon, PMID 29580359). But research also shows that TACE plus RFA improves survival compared to using TACE alone (Oncotarget, PMID 27936465).
Arsenic trioxide (Trisenox) given after TACE was compared to using TACE alone in a group of people with liver cancer that had spread to the lung (pulmonary metastasis). The study results suggest that giving arsenic trioxide after TACE was a more effective treatment than TACE alone. Liver tumours responded better to arsenic trioxide after TACE and there were fewer cases where the cancer spread outside the liver with this treatment (Journal of Gastroenterology and Hepatology, PMID 27517972).
Radioembolization (using TheraSphere yttrium-90 glass microspheres) combined with sorafenib is being studied to see if it is a better treatment than sorafenib alone for liver cancer that can’t be removed by surgery. Results are not yet published (JMIR Research Protocols, PMID 30111528).
Learn more about cancer research
Researchers continue to try to find out more about liver cancer. Clinical trials are research studies that test new ways to treat liver cancer. They also look at ways to prevent, find and manage liver cancer.
Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for liver cancer were first shown to be effective through clinical trials.
A thin, tube-like instrument with a light and lens used to examine or treat organs or structures in the body.
An endoscope can be flexible or rigid. It may have a tool to remove tissue for examination. Specialized endoscopes may have tools designed to examine or treat specific organs or structures in the body.
Specialized endoscopes are named for the organ or structure they are used to examine or treat.
An abnormal condition in which healthy liver tissue is replaced by scar tissue. Signs and symptoms include jaundice, fatigue, loss of appetite and itching of the skin.
Cirrhosis may be caused by infection with hepatitis A or B virus, drinking too much alcohol or other disorders.
Cirrhosis increases the risk of liver cancer.
The percentage of people with a given disease who are alive without any detectable disease (are disease-free) for a defined period of time.
For example, if cancer treatment results in a 70% disease-free survival over 5 years, then 7 out of every 10 people did not have any detectable disease for 5 years after treatment.
A procedure that removes or destroys cells, tissues or organs.
Ablation may be done by surgery, chemicals, heat, high-frequency electrical current, radiofrequency waves, lasers or other methods.
A drug that blocks the actions of the enzyme tyrosine kinase, which helps transmit the signals that occur after a growth factor binds to its receptor. Tyrosine kinase is involved in cell communication, development, division and growth.
Tyrosine kinase inhibitors are a type of growth factor inhibitor therapy. They may be used to help prevent tumour growth.
A harmless, inactive substance or treatment that looks the same as, and is given in the same way as, an active drug or treatment.
Placebos may be used in controlled clinical trials. One group is given a placebo and the other is given the substance or treatment being studied, then researchers compare the effects of the placebo and the active substance or treatment.
The amount of time after treatment that a person lives with a disease (such as cancer) without the disease getting worse.
Researchers may measure progression-free survival in clinical trials to find out how well a treatment works.
A flexible tube used to carry fluids into or out of the body.
For example, an intravenous catheter delivers fluid into the body through a vein and a urinary catheter carries urine from the bladder out of the body.
A procedure to reduce or block the main blood supply to a tumour and deliver chemotherapy drugs directly to the tumour.
Chemoembolization uses a synthetic blood vessel blocker mixed with chemotherapy drugs.