Liver Cancer Chemotherapy for Treatment

Liver cancer chemotherapy (chemo for short) is a type of treatment that uses cancer-killing drugs to stop or slow the uncontrolled growth of cancer cells. It can be used alone or in conjunction with other therapies like immunotherapy.

Chemotherapy is not commonly used in liver cancer treatment because the most common type (hepatocellular carcinoma) is often resistant to many chemo drugs. Additionally, not everyone with liver cancer may have a liver working well enough to cope with the chemo drugs. However, some types of liver cancer arising from the bile ducts (bile duct cancer) are sensitive to chemotherapy and immunotherapy. When chemotherapy is used, it is usually in people whose liver cancer:

• Cannot be treated with surgery
• Has not responded to local therapies like ablation and embolization or
• Is no longer responding to targeted therapy.

While it cannot cure liver cancer, chemotherapy can help to control tumor growth, shrink the liver tumor and alleviate symptoms.

Learn more:

Liver Cancer Basics: What You Need to Know

The 3 Most Common Liver Cancer Types

When cells grow and divide to form new cells, they go through a series of phases called the cell cycle, which involves copying their genetic material (or DNA). Chemotherapy works by interfering with DNA and the cell cycle, preventing the cells from dividing uncontrollably. This can kill the cancer cells or slow their progression.

Chemotherapy drugs are unable to differentiate between healthy cells and cancer cells, which means that healthy cells can be affected by these drugs. However, most normal, healthy cells are able to repair the damage caused by chemotherapy and will recover from its effects over time. On the other hand, because cancer cells are mutated (altered), they usually do not recover from the effects of chemotherapy, making it an effective treatment for cancer. Moreover, cancer cells are more vulnerable to chemotherapy drugs because they form new cells at a much faster rate than normal cells. This makes them more susceptible to chemotherapeutic drugs, which interfere with DNA and the cell cycle.

Chemotherapeutics used to treat liver cancer work by damaging DNA and disrupting the cell cycle in various ways. These types of drugs include:

Alkylating agents

Alkylating agents are a class of drugs that prevent cancer cells from dividing by damaging DNA directly. These drugs work in all cell cycle phases and are commonly used to treat numerous types of cancer. Examples of alkylating agents used for liver cancer treatment include cisplatin and oxaliplatin.

Antimetabolites

Antimetabolites are drugs that interfere with DNA and RNA by acting as substitutes for the normal building blocks of these two biomolecules. As a result, cancer cells can no longer create copies of their genetic material and are thus unable to divide and form new cells. Examples of antimetabolites used to treat liver cancer include 5-fluorouracil (5-FU), floxuridine, gemcitabine and capecitabine.

Antitumor antibiotics

Antitumor antibiotics work in two ways. First, they disrupt the creation of proteins, which are necessary for cell survival, by preventing ribonucleic acid (RNA) synthesis. Second, they can break up DNA strands and slow or stop the process of synthesizing DNA, which cells need to grow and survive.

Anthracyclines are a type of antitumor antibiotic that interferes with enzymes responsible for copying DNA during the cell cycle. Enzymes are proteins that start or accelerate chemical reactions in cells. Doxorubicin and mitoxantrone are two anthracyclines used to treat liver cancer.

In general, cisplatin, oxaliplatin, 5-FU, doxorubicin and gemcitabine are the chemo drugs proven to be most effective in treating liver cancer. However, these drugs still only shrink a small number of liver tumors and the responses usually do not last long.

Different chemotherapy drugs can be used together as part of your chemotherapy regimen. Your doctors will decide which drug combination is best for you depending on factors such as the stage of your cancer and other health considerations. Common chemo drug combinations for liver cancer include:

• GEMOX: gemcitabine, oxaliplatin
• CISGEM: cisplatin, gemcitabine
• FOLFOX: leucovorin, 5-FU and oxaliplatin

The field of cancer research continues to look into new chemotherapy drug combinations that can potentially be used to treat liver cancer. This could lead to more efficient treatment methods and improved outcomes for the future of liver cancer patients.

Chemotherapy can be given in various ways.

Systemic chemotherapy

Chemotherapy drugs can be administered orally or as an infusion into your veins (intravenously), after which they travel through the bloodstream to kill cancer cells throughout the body. This is known as systemic chemotherapy, which is especially useful for cancers that have metastasized.

Your medical oncologist will administer chemotherapy in cycles, which consist of treatment sessions with periods of rest in between. Each cycle typically lasts for a few weeks. Most chemotherapy regimens last for up to eight cycles over three to six months. However, the frequency of your treatment sessions and the duration of your chemotherapy regimen may vary depending on the makeup of your liver cancer and the drugs used.

Regional chemotherapy

Because traditional chemotherapy may not be effective in treating liver cancer, doctors sometimes recommend another form of chemo known as regional chemotherapy, where chemotherapeutics are administered specifically to the liver to target cancer cells in that area. By allowing a more concentrated amount of chemo drugs to reach the liver tumor, regional chemotherapy is usually more effective than traditional systemic chemotherapy. It can also cause fewer side effects by limiting the amount of chemotherapeutic drugs reaching other parts of the body. Regional chemotherapy is more commonly used to treat primary liver cancer.

Two examples of regional chemotherapy in liver cancer are chemoembolization and hepatic artery infusion (HAI). Chemoembolization involves the insertion of a catheter through a small cut in your inner thigh that is threaded up into the hepatic artery in your liver. Chemo drugs are administered through the catheter and directly into the artery, just before it is plugged with an embolic agent to block the blood supply to cancer cells in the liver.

HAI also involves delivering chemo drugs directly into the hepatic artery, but differs from chemoembolization in that an infusion pump is surgically implanted beneath the skin of the lower abdomen. This pump is linked to a catheter that connects to the hepatic artery. Subsequently, chemotherapeutics are injected with a needle through the skin and into the pump reservoir, where they are released gradually into the hepatic artery. Normal, healthy liver cells are able to break down most of the chemo drugs before they can reach other regions of the body, while cancer cells in the liver are destroyed. Floxuridine, cisplatin and oxaliplatin are the chemotherapy drugs most commonly used for HAI. Early studies have shown that HAI is effective in shrinking liver tumors, which can make them more amenable to surgical removal. Recent evidence suggests that HAI can also prolong survival in people with primary liver cancer.

HAI may be used to treat very large liver tumors that cannot be surgically removed or treated entirely with chemoembolization. However, because surgery is needed to insert the pump and catheter, it may not be useful for all people with liver cancer, especially those unable to tolerate major procedures and operations.

Chemotherapy drugs work by attacking cancer cells that are rapidly dividing. However, other healthy cells in the body that also divide quickly, such as hair follicles and those in the bone marrow, are likely to be affected. This leads to side effects, some of which are:

• Hair loss
• Mouth sores
• Appetite loss
• Nausea and vomiting
• Diarrhea
• Higher risk of infections (due to low white blood cell counts)
• Bruising or bleeding (due to low blood platelet counts)
• Fatigue (due to low red blood cell counts)

Your doctor(s) will usually provide you with medication to manage some of these side effects. But if these problems grow more severe or if they do not resolve, do inform your healthcare providers.

Your doctors will take into account several factors when deciding whether you should receive chemotherapy as part of your treatment plan. These include the type of liver cancer you have, the cancer’s stage and other factors, like your overall health. Chemotherapy can also take a toll on your body, so it is also important to take care of your mental and emotional health as you undergo this journey. You may find it helpful to seek support from friends and family, as well as resources provided by your cancer care team. They can provide emotional support, assist with daily tasks and offer a listening ear when you need it most. If you have any questions regarding chemotherapy, consult your doctors and cancer care team.