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Liver cancer is one of the most quickly increasing types of cancer in the United States due to a poor lifestyle causing obesity, diabetes, high cholesterol and high blood pressure. Once mostly seen in older adults and patients with hepatitis, it is now seen in younger patients and those without hepatitis.?

Cancers that begin in the liver are called primary liver cancers. They are named after the types of cells where the cancer begins. Hepatocellular carcinoma is the most common type of primary liver cancer. This tumor begins in the liver¡¯s hepatocyte cells when the cells divide uncontrollably.?

Hepatocellular carcinoma is related to underlying chronic liver disease caused by:

• hepatitis B or C
• alcohol use
• fatty liver or metabolic syndrome

Since hepatocellular carcinoma is diagnosed in people with existing liver disease, only 15% to 20% of patients can receive surgery or a liver transplant. But more than 70% of people with hepatocellular carcinoma may have cancer return after surgery, which is associated with a poorer prognosis and shorter survival.?

Thanks to new research, there is good news in the treatment of hepatocellular carcinoma. To learn more, we spoke with liver cancer expert

What are the important features of hepatocellular carcinoma?

Hepatocellular carcinoma tumors have a lot of immune cells in the tumor. These immune cells are not active, but treatment with immunotherapy can activate them against the tumor.?

Hepatocellular carcinoma tumors are also very vascular tumors. This means they form from blood vessels that grow abnormally. Vascular endothelial growth factor (VEGF) is a signal protein produced by many cells that causes the formation of blood vessels and changes the number and type of immune system cells in and around tumors. The overexpression of VEGF has been seen in hepatocellular carcinoma tumors.

How has hepatocellular carcinoma historically been treated?

One of the first treatments for treating advanced hepatocellular carcinoma was a targeted therapy drug called sorafenib. It targets the VEGF receptor by blocking the growth of blood vessels and cancer cells.?

In 2007, sorafenib became the first drug approved by the Food and Drug Administration (FDA) to treat some patients with hepatocellular carcinoma. This drug helped stabilize the tumors, but it only extended patients¡¯ lives by a few months

For the next decade, studies of other treatments showed little progress and were not shown to be better than sorafenib. Between 2017 and 2020, there were a handful of positive trial results.?

How did the IMBrave150 clinical trial change hepatocellular carcinoma treatment??

The IMBrave150 Phase III clinical trial combined an immune checkpoint inhibitor called atezolizumab with bevacizumab, a targeted anti-EGFR therapy that starves tumors by preventing new blood vessels from growing. When compared to sorafenib, it showed that patients whose hepatocellular carcinoma was unable to be surgically removed and that was treated with atezolizumab and bevacizumab lived longer than those treated with sorafenib.

On May 29, 2020, the FDA approved this drug combination for people with liver cancer that has spread or that can¡¯t be treated with surgery based on the study results.

What is the IMbrave050 clinical trial?

At the 2023 American Association of Cancer Research (AACR) Annual Meeting, IMbrave investigators will share preliminary results from the IMbrave050 trial. As one of the trial¡¯s global investigators, I worked with an MD Anderson team to develop the study design and biomarker strategy. Based on the antitumor activity seen in the earlier clinical trial, the study evaluated the same drug combination in delaying or preventing cancer returning in patients with high-risk hepatocellular carcinoma after surgery. After surgery, patients either received the drug combination or were monitored through active surveillance.?

The results show that atezolizumab plus bevacizumab is the first treatment given after surgery to demonstrate that patients lived longer without their cancer returning compared to those in active surveillance.

Why are these clinical trial results important for the future of hepatocellular carcinoma treatment?

These trial results indicate that this drug combination given after surgery has the potential to set a new standard of care for hepatocellular carcinoma treatment. We will continue to monitor these patients and provide long-term results, but this is a major step for patients with hepatocellular carcinoma.?

Is there anything that newly diagnosed patients should know about hepatocellular carcinoma?

One of the major challenges to managing this disease is that patients with advanced disease cannot have surgery. If you have one of the risk factors for this disease, talk to your doctor about screening strategies. National guidelines recommend a blood test and an ultrasound every six months.?

This is not a common cancer and needs to be treated by an expert. If you are diagnosed with hepatocellular carcinoma, you need to be treated by a multidisciplinary team like we have here at MD Anderson. That way, your care team can provide a personalized treatment strategy and offer clinical trials for liver cancer to give you the best chance for successful treatment.?

or by calling 1-877-632-6789.

The liver is your body¡¯s largest organ. It¡¯s responsible for digestion, blood clotting and helping get rid of toxins. But unlike other organs, it has two blood sources. This makes the liver vulnerable to cancer cells moving through the bloodstream. The cancers that most commonly spread to the liver through the bloodstream are colorectal, breast and lung cancers.

When cancer starts in the liver, it¡¯s called hepatocellular carcinoma. This type of liver cancer can start as a single tumor or as multiple spots on the liver caused by heavy drinking, obesity or a long-term hepatitis infection. These conditions cause scarring and permanent damage, known as cirrhosis of the liver.

To learn more about liver cancer symptoms, diagnosis and treatment, we spoke with Here¡¯s what she had to say.

What are common symptoms of liver cancer?

Many patients don¡¯t experience any symptoms in the early stages of liver cancer. When symptoms do develop, they may include abdominal pain or bloating, fatigue, nausea, vomiting, and yellowing of the skin or eyes, known as jaundice. Keep in mind that these symptoms vary from person to person.

Are some people more likely to develop liver cancer?

Hepatocellular carcinoma is more common in men than women, and the average age of diagnosis is 63.

Patients with cirrhosis of the liver are more likely to develop hepatocellular carcinoma, so it¡¯s important to understand what can lead to cirrhosis:

• Alcohol consumption: Alcohol should be avoided. Talk with your doctor about what that means for you.
• Chronic hepatitis infection: Hepatitis B and C increase your risk, so it¡¯s important to seek treatment if you have either of these infections. New antiviral medications can treat both types.
• Non-alcoholic fatty liver disease: This is caused by a buildup of fat in the liver. You can lower your risk by maintaining a healthy weight, eating a plant-based diet and staying active.
• Genetic conditions: Hemachromatosis, Wilson disease, Alpha 1-antitrypsin deficiency, porphyria and other rare conditions can lead to cirrhosis. If you have a family history of liver cancer, talk with your doctor about whether you should meet with a genetic counselor.

What are screening options are available for liver cancer?

National guidelines recommend routine screening liver cancer screening for patients with cirrhosis. This includes a blood test for a cancer marker called alphafetoprotein as well as an ultrasound looking for any suspicious liver masses. This screening regimen is typically done every six months. Your doctor can advise if this is right for you.

How is liver cancer diagnosed?

Talk to your doctor if you have any liver cancer symptoms. Your doctor may order a CT scan or an MRI along with an alphafenoprotein blood test to look for cancer. In some cases, CT scans or MRI results, along with blood test results, may be enough to make a diagnosis. But if the images aren¡¯t clear, your doctor may remove a tissue sample for closer examination by doing a biopsy.

How is liver cancer treated?

The type of liver cancer treatment your doctor recommends will depend on the tumor¡¯s size and location, whether you have cirrhosis, and your overall health.

If the cancer is early stage and your liver is healthy, surgery may be an option. If the tumors are small and haven¡¯t spread to nearby blood vessels, your doctor may suggest a liver transplant.

Sometimes surgery isn¡¯t an option, especially if the tumor is too large to be removed safely or is in a difficult location. In these cases, your doctors may recommend radiation therapy, which uses an external beam of X-rays or protons to destroy tumors. They may also suggest radiofrequency ablation, which uses a needle-thin probe to deliver electric currents directly to the tumor, heating it until it¡¯s destroyed.

Another approach is to prevent blood flow from reaching tumors through a process called chemoembolization. A needle is inserted into an artery in the groin, and a tiny tube is threaded into the artery that leads to the liver to deliver drugs to the tumor. Afterward, the artery is blocked to prevent blood flow to the liver. In some cases, patients may instead undergo radioembolization, where the doctor injects liquid containing tiny radioactive spheres that treat the tumor.?

Chemotherapy and immunotherapy may also be options for some patients.

What¡¯s next for liver cancer treatment? Tell us about promising research developments and clinical trials here at MD Anderson.

Unfortunately, liver cancer is one of the most rapidly increasing types of cancer in the U.S. But we¡¯re hopeful for the future based on new research. At MD Anderson, we have several clinical trials exploring new liver cancer treatments.

One clinical trial is comparing chemotherapy with a type of radiation called stereotactic body radiotherapy, which delivers a high dose of radiation precisely to the tumor while limiting exposure to healthy cells.

Another clinical trial is comparing proton therapy with intensity-modulated radiotherapy, and others are looking at T-cell therapy for patients with advanced liver cancer. MD Anderson is also investigating using microscopic glass beads called TheraSpheres to target tumors with internal radiation in a treatment called radioembolization.

What advice do you have for liver cancer patients?

There are many liver cancer treatment options, but not all options are right for all patients. And weighing through these treatment options can be overwhelming, so make sure you find a team of doctors you trust who can answer your questions and help you choose the right treatment for you. ?

or by calling 1-877-632-6789.