Not everyone responds to hepatocellular carcinoma (HCC) treatment in the same way. If your therapy isn’t doing what it’s supposed to do, you’ll want to have some idea what will happen next.
Get information on the latest treatments, drug trials, and what to ask your doctor here.
Your doctor will create your initial treatment plan based on factors such as:
- the stage of the cancer at diagnosis
- whether or not the cancer has grown into blood vessels
- your age and general health
- if surgical resection or liver transplant is possible
- how well your liver functions
In early stage liver cancer, surgery to remove the tumor and a small part of your liver may be all you need. If the cancer hasn’t metastasized, you may be eligible for a liver transplant. If surgery isn’t an option, various ablation techniques can destroy small tumors in the liver without removing them.
You might also need some ongoing treatments such as radiation or chemotherapy. Whatever therapies you ultimately choose, your healthcare team will follow up to see how well they’re working. Your doctor may adjust your treatment plan as needed.
The following are a few other things to keep in mind when treatment isn’t effective.
HCC can be treated with drugs that target specific changes in cells that cause cancer. Once in your bloodstream, these drugs can seek out cancer cells anywhere in your body. That’s why they can be used for cancer that has spread outside the liver.
For liver cancer, sorafenib (Nexavar) may be the first drug your doctor will try. Cancer cells contain proteins that encourage them to grow, and this drug targets those proteins. Tumors also need to form new blood vessels to grow, and sorafenib blocks this action. There are generally fewer side effects than you would have with chemotherapy. Because it’s available in pill form, it’s also easier to take.
If sorafenib isn’t working, your doctor may recommend regorafenib (Stivarga). It works similarly, but is reserved for those who’ve already been treated with sorafenib.
A newer targeted therapy for advanced liver cancer is nivolumab (Opdivo), which is given by injection. Nivolumab was granted accelerated approval for people with HCC who’ve been treated with sorafenib. Early studies in people with advanced liver cancer show encouraging results.
If your doctor has recommended treatment with sorafenib, ask:
- What follow-up testing will be used to find out if it’s working?
- At what point will we know for sure that it’s time to make a change?
If sorafenib hasn’t worked, or as stopped working:
- Is the next step regorafenib or nivolumab?
- Which is the better option for me and why?
- How will we know if it’s working?
- If it doesn’t work, what are the next steps?
The process from research to getting a drug approved for treatment is long. Clinical trials are among the last steps in that process. These trials depend on people who volunteer for experimental treatments. For you, it means access to innovative treatments that aren’t yet approved for general use.
Ongoing trials for treatment of HCC include a variety of therapies that use the body’s immune system to fight cancer. These drugs include immune checkpoint inhibitors, monoclonal antibodies, adoptive cell therapy, and oncolytic virus therapies.
Your doctor can help guide you in the right direction. Here are a few questions to ask:
- Am I eligible for a clinical trial?
- What is the goal of the trial?
- What has been the experience with the new therapy so far?
- How will it be carried out and what will be asked of me?
- What are the potential risks?
While your oncology team is treating the cancer, you can also receive treatment for symptom management. Supportive care is also known as palliative care.
Palliative care specialists don’t treat the cancer itself per se. They’re trained to focus on pain and other symptoms from cancer and its treatment. Their goal is to improve your quality of life. They’ll coordinate with your other doctors to make sure your therapies work well together and to avoid adverse drug interactions.
You can also look into complementary and alternative therapies. These can include acupuncture, massage, and relaxation techniques. Be sure to consult with your doctor to make sure new therapies are safe for you and that you’re using qualified professionals.
Before taking new herbal or dietary supplements, ask your doctors if they will interfere with other medications.
Treating liver cancer often involves an extended team. Doctors and other healthcare professionals need to work together to provide personalized care.