How about targeted treatment for liver cancer? Pay attention to these matters in targeted treatment for liver cancer

Because liver cancer has no symptoms in the early stage, once it is discovered, it is usually in the terminal stage. The treatment of terminal liver cancer requires medication. So how to choose the medication for liver cancer? What are the targeted drug treatments for liver cancer? Let's have a simple understanding of this issue. I hope the following points will be helpful to everyone!

Liver disease treatment drugs are mainly divided into three categories: 1. Radiotherapy. Radiotherapy is mainly based on the rapid growth of tumor cells, hoping to treat through cytotoxic drugs. Therefore, this type of drug usually has great toxic side effects. The probability of radiotherapy shrinking the tumor is 6-8%, and it will damage liver function tests, resulting in most doctors being unwilling to use it and patients having low willingness to accept it. Therefore, it is rarely used in actual clinical work;

2. Targeted therapeutic drugs are drugs designed for the genetic variation characteristics of liver cancer. Due to the heteroscedasticity of liver cancer tumors (liver cancer cells are not the same type of cells, but are composed of cells with different characteristics), it is still a dead letter to test the genetic variation of liver cancer to guide medication. Testing genes is meaningless in guiding medication;

3. Immunity drugs, mainly immunity drugs represented by pD-1/pD-L1 antigen, whose mechanism of action is to eliminate the function in the human body that inhibits the body from destroying tumor cells, and "awaken" the body's ability to destroy tumor cells, thereby enabling the body itself to destroy tumor cells. At present, it is a type of drug with the greatest potential for curing liver cancer in the tumor treatment industry.

Today we mainly talk about targeted drug treatment for liver cancer. At present, there are only three targeted drugs for liver cancer approved by the UK and my country Food and Drug Administration. In order of approval time, they are Nexavar, Regorafenib, and Lenvatinib. The approved first-line drugs are Nexavar and Lenvatinib, and the second-line drugs are Regorafenib. What is the first-line drug? The first-line drug is the most effective and the first recommended. So what is the second-line drug? The second-line drug is the drug used when the first-line drug is ineffective or resistant, or when the first-line drug is unbearable.

Therefore, the targeted drug treatment of liver cancer is the question of how to choose the three drugs mentioned above. Since the first-line drugs are Nexavar and Lenvatinib, it is a question of which drug to choose from these two drugs. Then the question is, which of these two drugs is better? In a clinical study, the two drugs were compared. The objective efficacy (proportion of reduction) of Lenvatinib was 40%, and that of Nexavar was 13%. The probability of symptom suppression (stable reduction) of Lenvatinib was 73.8%, and that of Nexavar was 5. 8.4%, overall survival rate lenvatinib 13.6 months, Nexavar 12.3 months, these three indicators are the key indicators to measure drug efficacy. Since lenvatinib is better than Nexavar in these three indicators, then the preferred liver cancer targeted drug is lenvatinib rather than Nexavar. In fact, in Chinese liver cancer patients (the causes of liver cancer in Eastern and Western populations are different), lenvatinib has better efficacy than Nexavar in experimental data, so lenvatinib is more suitable for Chinese liver cancer patients. In addition to efficacy, we also need to look at the side effects of the two. From the data of clinical studies, the probability of side effects of the two drugs is similar, but the types of occurrence are different. The incidence of hypertension of lenvatinib is higher, while the hand-foot syndrome (ulcers on the hands and feet) of Nexavar is more common. Some people say that I should use Nexavar first, and then take lenvatinib when I develop drug resistance. Is that possible?

In fact, taking Nexavar first can reduce the chance of tumor shrinkage by less than 10%. In other words, if there is no effect at the beginning, there is no such thing as drug resistance. Moreover, liver cancer grows rapidly. Once the wrong choice is made, the subsequent treatment will miss the opportunity. Therefore, the targeted treatment drug for liver cancer should be lenvatinib instead of Nexavar, and after lenvatinib resistance, regorafenib, cabozantinib (the preferred choice for c-met) or ramucirumab should be selected. The latter two drugs have not yet been approved by the US FDA, but phase 3 clinical studies have shown good results. In summary, the method of adopting targeted treatment drugs for liver cancer is to give priority to lenvatinib, and then use regorafenib if resistance occurs.