A combination of chemotherapy (cisplatin) and biologic therapy (interferon-alfa) appears to result in a prolonged survival time over the use of cisplatin alone in some persons with advanced liver cancer. This cisplatin (administered through an artery) and interferon-alfa (delivered by injection under the skin) regimen was effective against liver cancer that had spread to the portal vein or to other parts of the body, according to a recent report by Korean researchers.
Primary cancer of the liver is characterized by the cancer cells that begin to grow in the liver, the largest organ in the human body. These cancer cells can then spread to the veins or arteries of the liver and/or to other parts of the body (called advanced or metastatic disease). The most common type of primary liver cancer is called
hepatocellular carcinoma. Treatment of primary cancer of the liver depends largely on the stage of disease (extent of disease at diagnosis). When possible, the cancer is surgically removed from the liver. However, many cancers of the liver are too advanced to be completely removed by surgery. For persons with advanced liver cancer, treatments such as chemotherapy, radiation therapy, radiolabeled antibody therapy, radiofrequency ablation, cryosurgery, alcohol injection, other types of surgery, or biologic therapy (to help the immune system) may be used to control the cancer, relieve the symptoms of disease, and prolong survival time.
When chemotherapy is used to treat advanced liver cancer, multiple approaches to administering the chemotherapy drugs may be considered.
Systemic chemotherapy is administered by infusing the drugs into the body’s bloodstream through a vein (called intravenous infusion) or artery (intra-arterial infusion), killing cancer cells within and outside the liver. In the case of regional chemotherapy, the goal is to send the chemotherapy drugs more directly to the cancer cells in the liver. For example, 1) the drugs can be pumped into the vein that goes directly to the cancer cells in the liver; or 2) the main artery supplying the liver (called the hepatic artery) can be blocked and the drugs injected between the blockage and the liver so that they go primarily to the tumor in the liver (called chemoembolization of the hepatic artery). Many of the newer chemotherapy strategies and other newer types of therapy are currently being studied in clinical trials (research studies); however, the more aggressive approaches are not always options for persons who have cancer that involves the major blood vessels of the liver (the hepatic artery and portal vein). Researchers continue to develop and study new methods of chemotherapy delivery in the hope of providing more effective treatment options to persons with advanced liver cancer, including those with involvement of the portal vein or hepatic artery. Recently, researchers in Korea combined the use of intra-arterial chemotherapy with a biologic therapy, called interferon-alfa, in an effort to kill the cancer cells directly while also helping the immune system to fight the cancer.
The researchers treated 68 persons who had advanced liver cancer (hepatocellular carcinoma) that either involved the portal vein or had spread to other parts of the body. The patients received 1 of 3 treatment regimens: A) intra-arterial chemotherapy with cisplatin plus biologic therapy with interferon-alfa by injection (C/I); B) intra-arterial chemotherapy with cisplatin alone; or C) the best supportive care available to relieve symptoms and provide comfort. The results showed a 33% partial response rate with the C/I combination, compared with a 14% rate with the cisplatin alone. After 1 year, 27% of those receiving the C/I combination, 9% of those receiving cisplatin only, and 0% of those receiving the best supportive care were alive. The average survival times for patients were 19 weeks in those receiving the C/I combination, 11 weeks in those receiving cisplatin only, and 5 weeks for those receiving the best supportive care.
These researchers concluded that the use of intra-arterial cisplatin and interferon-alfa by injection provided a benefit over intra-arterial cisplatin alone in persons with advanced liver cancer that had spread to the portal vein or other parts of the body. Persons who have this type of disease may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which a similar treatment regimen or another promising new treatment strategy is being studied. (Cancer, Vol 88, No 9, pp 1986-1991, 2000)