Chemotherapy

Chemotherapy refers to a large variety of powerful drugs used to treat patients with cancer. Chemotherapy can be given directly into the body through a vein or artery (intravenous or intraarterial); by mouth with pills or liquids (orally); or by injections into the skin, the muscle or directly into the tumor (subcutaneous, intramuscular or intratumoral).

Chemotherapy may involve the use of one drug or a combination of drugs depending on the type of cancer. Also, drug therapy may be used along with other treatments, such as surgery or radiation, to eliminate as many cancer cells as possible.

Side effects of chemotherapy depend on many things, including the type of cancer and the specific drugs being used. Fortunately, doctors have developed a variety of therapies to help prevent and/or lessen the side effects that a patient may experience while receiving chemotherapy treatment.

Oncologists use chemotherapy drugs either alone or in combination. When tumors can not be surgically removed or have metastasized to other parts of the body, chemotherapy can stabilize or slow down the growth of the tumor, relieve the tumor- related symptoms (palliation) and hopefully improve survival. Chemotherapy can also reduce the risk of cancer recurrence following surgery (adjuvant therapy). to Chemotherapy can be given prior to surgery (neoadjuvant therapy) in an attempt to shrink the tumor to facilitate surgical resection. Lastly, chemotherapy can be given in combination with radiation. In this case, the drugs serve as radiosensitizers to make radiation work better.

Many classes of chemotherapy drugs have been tested either alone or in combination in patients with hepatobiliary cancers, with limited success. HCCs are heterogeneous due to multiple etiologies and risk factors and may have different pathways that lead to cancer development. Most patients have underlying cirrhosis with various complications that limit the selection and adequate dosing of most chemotherapy agents because most drugs require good liver function to convert the drugs. Lastly, HCC tumors have the capacity to pump drugs outside of cells and therefore confer resistance to chemotherapy.

"Targeted" Therapy
Targeted therapy refers to drugs that are designed to attack cancers based on the specific abnormalitiespresent in cancer cells. These drugs have been tested extensively through clinical trials and have shown success in many tumor types including some of the traditionally "chemotherapy-resistant" tumors such as hepatocellular cancer.
The most exciting development for the treatment of advanced HCC is the recent approval of a multitargeted drug, sorafenib (nexavar). This drug targets several pathways critical for tumor growth including angiogenesis and proliferation. Based on a large randomized placebo-controlled phase III study (about 300 patients in each arm), patients who took sorafenib lived longer (by 2.8 months) and had longer time to control tumor. Sorafenib has become the standard of treatment in patients with advanced HCC.
This drug has several side effects including hand-and-foot syndrome (a type of skin reaction in the palms and soles), diarrhea, and fatigue. You need to be monitored closely by your oncologist or hepatologist while taking this drug so that the dosage can be adjusted or interrupted in case you develop worsening side effects. Since this drug was approved based on the experience in patients with good liver function, it should be given with caution for patients with compromised liver function.

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Chemotherapy

"Targeted" Therapy