How is the effect of immunotherapy for liver cancer? Comprehensive analysis of immunotherapy for liver cancer

The incidence of liver cancer ranks fourth in Taiwan (Note 1), but the mortality rate is very high. Recently, it has almost always been the second most deadly cancer in China, which makes many people shudder when they hear about liver cancer. Why is liver cancer so dangerous? Is it because its tumor cells are very strong and unyielding? I don't think so. In fact, the chances of recovery of early liver cancer are very high, and the success rate of surgical removal and electrocautery is very high. However, when most liver cancers are diagnosed, they are already in the late stage. Common symptoms of patients with late-stage liver cancer include right upper abdominal pain, fever, jaundice, shortness of breath, loss of appetite, abdominal distension caused by ascites, and gastrointestinal bleeding caused by excessive pressure in the portal vein. However, because the liver has no nerves and can maintain normal function with only 1/4, these symptoms are basically difficult for patients to detect in the early stage. Until they find discomfort, they will go to the doctor. Generally, the tumor is already very large and even affects other functions.

For patients who are in the terminal stage and cannot undergo surgery, the tumor can be eliminated by electrocautery, ethanol injection, and vascular embolization. In recent years, there are also many kinds of targeted therapy drugs that can be used, but generally speaking, the treatment effect is not very good for patients in the terminal stage.

Immunotherapy for liver cancer is developing

After 2013, the concept of cancer immunotherapy was confirmed. Scientists found the mechanism of tumor cells to avoid cellular immune attack and successfully used drugs to block it. Since then, the medical community has basically started the research of cancer immunotherapy. Tumor cells can absorb these immune checkpoint proteins and use them to suppress the immune response and reduce the fighting ability of the human immune system. Therefore, the development of immune checkpoint inhibitor drugs can block the activity of immune checkpoint proteins and enhance the ability of the immune system to destroy tumor cells. It has also seen promising results in the treatment of liver cancer.

In the second phase of the global clinical study of liver cancer, patients who still failed to respond to targeted drugs were given immunotherapy (Nivolumab), and 22% of the patients were able to effectively control the tumor, so that it no longer expanded, or even part or all of the tumor disappeared. If the best results in the past years were used for statistical analysis, the percentage of tumor control could even be as high as 55%, and it was immediately approved by the US Food and Drug Administration (FDA) as a second-line drug for liver cancer on September 22, 2017. In the eyes of many people, they may think that the percentage of 22% is not high, but if you look back, the targeted drugs that have long been considered as a magic weapon for treatment actually have a response rate of only 2% for liver cancer.

Another immune checkpoint inhibitor (pembrolizumab) in the second phase of global clinical trials for liver cancer, allowing patients who have not responded to targeted drugs to receive immunotherapy, about 18% of patients can effectively control the tumor, so that the tumor partially or completely disappears. The proportion of tumors controlled can even be as high as 60%, and it has also been approved by the US Food and Drug Administration (FDA) as a second-line drug for liver cancer.

Regarding the survival of patients, relevant studies have found that compared with the simple use of targeted drugs, immunotherapy can make patients live nearly 5 months longer on average. Nearly 30% of patients can survive for more than 18 months, and in the next two years, the condition of these patients does not seem to have worsened.

Combination therapy of immune drugs will be the development trend in the future

In the future, there will be more immunotherapy experiments, including the combination of immune drugs and immune drugs, immune drugs and targeted drugs, and other combination therapies for liver cancer treatment. The medical community predicts that there will be more exciting results, which will benefit more liver cancer patients and allow liver cancer patients who receive immunotherapy to enjoy a better quality of life. According to the statistical analysis of clinical research reports, the symptoms of liver cancer patients after treatment are more common, such as rash, hyperthyroidism, hypothalamus and pituitary hyperactivity, and immune overreaction of the gastrointestinal tract and liver. Compared with nausea, vomiting or hair loss caused by radiotherapy, most of these symptoms can be controlled by drugs, and the overall discomfort is also mild.

In view of these results, the medical community still values ​​the potential of immunotherapy in the treatment of liver cancer, and encourages more liver cancer patients not to lose hope. However, we still need to remind patients that immunotherapy is expensive, and it is only in the development stage at present, and it cannot be guaranteed to be effective for everyone. Therefore, before receiving treatment, patients still need to consider their own economic situation. In the future, the direction of immunotherapy will inevitably become more personalized, and various tests will be used to predict treatment results.