Chemotherapy for Liver Cancer

Chemotherapy drugs are used to kill cancer cells. These drugs destroy cancer that is still left after surgery, slow the tumor's growth, or reduce symptoms. Most chemotherapy drugs are not effective for liver cancer. However, certain drugs do shrink a small proportion of liver tumors, although the response to the drugs does not always last. The drugs that seem to be most effective for liver cancer are:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride is an anthracycline antibiotic. Doxorubicin stops the growth of cancer cells, causing them to die. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer you have.
• Adrucil^® or Efudex^® (5-fluorouracil or 5-FU) - 5-FU is an antimetabolite drug. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size.
• FUDR^® (floxuridine) - Floxuridine is an antimetabolite drug. It stops cancer cells from growing, which kills them. Floxuridine is delivered directly into the liver by a pump -through the hepatic artery. It is usually given continuously over 14 to 21 days. The dose depends on your size.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends on the type of cancer you have, your size, and how well your kidneys work.
  
  

Chemotherapy can be classified into regional chemotherapy, systemic chemotherapy, and chemoembolizaton. Regional chemotherapy is the most common way to deliver chemotherapy for liver cancer.

• Regional (intraarterial) chemotherapy - The doctor makes an incision under the ribs and places a small pump under the skin. The pump injects chemotherapy drugs into a thin tube that is placed in the hepatic artery, which delivers oxygen-rich blood from the heart to the liver. This technique allows the doctor to deliver a much higher dose of chemotherapy directly into the liver with fewer side effects. Regional chemotherapy is used to treat liver cancer in patients who cannot have their cancer removed by surgery and those who have had their cancers removed, but who are at high risk of having their liver cancer come back (recur). FUDR is the most commonly used drug for regional chemotherapy treatment of liver cancer.
• Systemic chemotherapy - Systemic chemotherapy affects the entire body. You take systematic chemotherapy drugs in pill form or by injection into the vein. Because they affect normal cells and cancer cells, these drugs often cause side effects, such as nausea, loss of hair, and fatigue. These side effects usually stop when you complete the chemotherapy treatment.
• Chemoembolization - The doctor threads a catheter (thin, flexible tube) into an artery in the inner thigh and up into the hepatic artery, which delivers oxygen-rich blood that tumors need to survive. The doctor then injects a dye into the bloodstream and watches the dye move up the catheter through angiography, an x-ray procedure used to look at blood vessels. When the catheter reaches the liver, the doctor injects small particles containing chemotherapy into the hepatic artery. The particles block the flow of blood to the liver through the hepatic artery. Once the blood stops flowing, the tumor is soaked in a high concentration of chemotherapy drugs for a long time because no blood comes into the tumor to wash the drugs out. As a result, the tumor cells die very quickly. The procedure usually takes about 2 or 3 hours.
• Targeted therapy – Targeted therapy blocks the steps involved in the growth and proliferation of cancer cells. Targeted therapy may be taken by mouth in a pill form. The main targeted therapy for liver cancer is a drug called Nexavar^® (sorafenib tosylate).