The Food and Drug Administration (FDA) has approved three new liver cancer treatments in quick succession. This is promising news for those diagnosed with hepatocellular carcinoma (HCC, the most common form of liver cancer), which responds poorly to chemotherapy.
Hepatitis B and C viruses (HBV and HCV) raise the risk of liver cancer. Treating the viruses can mitigate this risk.
In 2007, Nexavar (sorafenib) became the first treatment approved to specifically target liver cancer. A decade later, the FDA green-lit a second targeted therapy, Stivarga (regorafenib), as well as the first immune-based treatment for the malignancy, Opdivo (nivolumab).
Between August 2018 and January 2019, the FDA doubled the number of liver cancer treatments with the approval of Lenvima (lenvatinib), Cabometyx (cabozantinib) and Keytruda (pembrolizumab). Like Nexavar and Stivarga, Lenvima and Cabometyx are kinase inhibitors. These drugs inhibit enzymes that play a role in the growth of cancer cells and the development of blood vessels that feed tumors. Keytruda and Opdivo are PD-1 checkpoint inhibitors that help immune cells fight cancer.
These new medications have not proved effective for all those with liver cancer. Furthermore, cancer can develop resistance to the drugs. Nevertheless, the recent FDA approvals provide clinicians with more options for selecting sequences of therapies that can better control the malignancy.
“These new drugs provide incremental advances that are likely to lead to improved survival in patients with advanced HCC,” says Daniel S. Fierer, MD, an infectious disease specialist at the Icahn School of Medicine at Mt. Sinai in New York City. “Pembrolizumab, with a very different mechanism than sorafenib and lenvatinib, provides the opportunity for combination therapy for advanced HCC.”