What's New in Liver Cancer Research?

Because there are only a few effective ways to prevent or treat liver cancer at this time, there is always a great deal of research going on in the area of liver cancer. Scientists are looking for causes and ways to prevent liver cancer, as well as ways to improve treatments.

Prevention

Some scientists believe that vaccinations and improved treatments for hepatitis could prevent about half of liver cancer cases worldwide. Researchers are studying ways to prevent or treat hepatitis infections before they cause liver cancers. Research into developing a vaccine to prevent hepatitis C is ongoing. Progress is also being made in treating chronic hepatitis.

Screening

Several new blood tests are being studied to see if they can detect liver cancer earlier than using  AFP and ultrasound. Ones being studied include DCP, Glypican-3, osteopontin and Golgi protein-73. CT scans and MRI scans are also being studied as different imaging tests to screen for liver cancer instead of ultrasound.

Surgery

Newer techniques are being developed to make both partial hepatectomy and liver transplants safer and more effective.

Adding other treatments to surgery

An active area of research uses adjuvant therapies – treatments given right after surgery – to try to reduce the chances that the cancer will return. Most of the studies so far using chemotherapy or chemoembolization after surgery have not shown that they help people live longer. Research studies are also looking into newer drugs, like targeted therapy and may prove to be more effective. Some promising results have also been seen with radioembolization, but these need to be confirmed in larger studies. Another area studied has been the use of anti-viral therapy in people with liver cancer related to having viral hepatitis to see if it improves outcomes after surgery.

Doctors are also studying ways to make more liver cancers resectable by trying to shrink them before surgery. Studies are now looking at different types of neoadjuvant therapies (therapies given before surgery), including targeted therapy, chemotherapy, ablation, embolization, and radiation therapy. Early results have been promising but have only looked at small numbers of patients.

Determining recurrence risk after surgery

After a partial hepatectomy, one of the biggest concerns is that the cancer might come back (recur). Knowing someone's risk for recurrence after surgery might give doctors a better idea of how best to follow up with them, and may someday help determine who needs additional treatment to lower this risk.

Researchers are studying ways to predict if the cancer will come back by testing the liver cells in the surgery sample through genetic profiling. These studies are promising but will need to be confirmed in other larger studies before it is widely used.

Ablation therapy

Newer ablation techniques are being studied. One type, called irreversible electroporation, is an ablation procedure that does not use heat or cold to destroy cancer cells. It uses high voltage to open the "pores" of the cell (like the pores of your skin) which causes the cancer cells to die. It may be very useful for cancers that are in difficult areas to treat, such as near blood vessels.

Targeted therapy

New drugs have been developed that work differently from standard chemotherapy drugs. These new targeted drugs act on specific proteins in cancer cells or their surrounding environments.

Tumor blood vessels are the target of several newer drugs. Liver tumors need new blood vessels to grow. The drug sorafenib (Nexavar), which is already used for some liver cancers that can't be removed surgically, works in part by hindering new blood vessel growth. This drug is now being studied for use earlier in the course of the disease, such as after surgery or trans-arterial chemoembolization (TACE). Researchers are also studying whether combining it with chemotherapy may make it more effective.

Ramucirumab (Cyramza) is another targeted drug that works on blocking new blood vessel growth which can result in tumor shrinkage. It is already being used in other cancers such as stomach cancer, NSCLC and colorectal cancer. It is being studied in people with liver cancer with positive results.

Biomarkers

Knowing which liver cancers will respond to certain treatments before giving them would help save people from side effects of unhelpful drugs. Research is being done to look for specific biomarkers (proteins) such as p-ERK, or genomic profiling (specific gene changes of a cancer) to see if targeted therapy or immunotherapy can be chosen based a tumor's special traits.

Virus therapy

A newer approach to treatment is the use of a virus, known as JX-594. This started as the same virus that was used to make the smallpox vaccine, but it has been altered in the lab so that it mainly infects cancer cells and not normal cells. A solution containing the virus is injected into liver cancers, and the virus can enter the cancer cells, where it causes them to die or to make proteins that result in them being attacked by the body’s immune system. Early results of this treatment against advanced liver cancer have been promising, even in patients who have already had other treatments.