How do patients with liver cancer choose genetic testing to truly achieve precise treatment?

The occurrence of cancer is ultimately due to genetic abnormalities that cause mutant cells to grow in an uncontrolled state, dividing and multiplying endlessly. In this sense, cancer is fundamentally a genetic disease, though external factors such as high life pressure, low immunity, smoking and drinking, irregular work and rest, obesity, radiation, infectious pathogens like hepatitis B virus, and carcinogens like aflatoxin all contribute to triggering these gene errors. After more than a decade of development, cancer genetic testing has become an immediate need for a large number of cancer patients. The test report guidance provided by tumor genetic testing perfectly fits the concept of precision medicine, helping patients choose targeted drugs for precise treatment, avoid detours, and reduce unnecessary side effects. Only by classifying the essential characteristics of liver cancer at the molecular level can early diagnosis, prognosis judgment, and personalized treatment truly be achieved.

Sorafenib (Nexavar) is a dual-effect targeted drug that prevents the formation of new blood vessels needed for tumor growth while also targeting proteins that promote cancer cell growth. Its main targets include VEGFR-1/2/3, RET, FLT3, and BRAF. It is suitable as first-line treatment for advanced liver cancer that cannot be operated on or has metastasized, and is taken orally twice daily. Common side effects include fatigue, rash, loss of appetite, diarrhea, and high blood pressure, with rare serious side effects including heart blood flow problems and stomach or intestinal perforation.

Regorafenib (Stivarga) is an oral multi-target kinase inhibitor structurally similar to sorafenib, capable of inhibiting VEGFR-1/2/3, TIE-2, BRAF, KIT, RET, PDGFR, and FGFR to block tumor angiogenesis and suppress cancer cell growth. It was approved by China's CFDA in December 2017 for patients with hepatocellular carcinoma who previously received sorafenib treatment, taken orally once daily for three consecutive weeks followed by one week of rest. Common side effects include fatigue, hand-foot syndrome, high blood pressure, and diarrhea.

Lenvatinib (Lenvima) is a multi-targeted drug whose main targets include VEGFR1-3, FGFR1-4, PDGFR-α, cKit, and RET. It works by preventing tumors from forming new blood vessels needed for growth and was approved by the US FDA and included in China's CSCO liver cancer guidelines as first-line treatment for non-surgical advanced liver cancer. It is taken orally once daily, with common side effects including palmar-plantar redness syndrome, loss of appetite, diarrhea, and high blood pressure.

Cabozantinib is a small molecule multi-target inhibitor developed by Exelixis that targets VEGFR, MET, NTRK, RET, AXL, and KIT. The FDA approved it on May 29, 2018 for second-line treatment of advanced liver cancer based on the Phase III CELESTIAL trial, which demonstrated significantly improved overall survival, progression-free survival, and objective response rate in patients with advanced hepatocellular carcinoma who had progressed after sorafenib treatment.

Nivolumab (Opdivo) targets the PD-1/PD-L1 signaling pathway, blocking PD-L1 protein binding to cancer cells and removing their immune camouflage so the body's immune cells can recognize and eliminate them. On September 23, 2017, the FDA approved Opdivo for advanced liver cancer patients after sorafenib treatment failure, with an effective rate of 20% and a disease control rate of 64% based on the Checkmate-040 clinical trial.

Larotrectinib (Vitrakvi), approved by the FDA on November 27, 2018, is a broad-spectrum anticancer drug for adult and pediatric patients with locally advanced or metastatic solid tumors carrying NTRK gene fusion — including NTRK1, NTRK2, or NTRK3. It is effective across many different tumor types as long as NTRK gene fusion is confirmed through genetic testing, making it uniquely valuable as a tumor-type-agnostic targeted therapy.

With dozens of genetic testing institutions now available on the market, patients must carefully select genetic testing companies to ensure accuracy and clinical relevance. Two leading precision genetic testing technologies from the United States stand out as particularly reliable options.

Caris multi-platform molecular analysis from Caris Life Sciences is considered an optimal choice for cancer patient genetic testing because it encompasses not only DNA-level genetic analysis but also RNA and protein-related molecular testing — a comprehensive approach that other genetic testing companies do not offer. This multi-platform approach allows for a more thorough analysis of tumor variation, resulting in more authoritative drug guidance. In a large solid tumor study of 1,180 patients guided by Caris analysis, patients experienced prolonged survival of 422 days. Guided patients used an average of 3.2 medications compared to 4.2 for unguided patients, reducing unnecessary side effects and economic burden. The technology covers virtually all cancer types and can guide not only targeted drug selection but also chemotherapy and hormone drug choices, as well as access to the latest US clinical trials. Key molecular targets analyzed include EGFR, ALK, ROS1, MET, mTOR, BRAF, HER2, PD-L1, TMB, and MSI-H.

FoundationOne CDx was approved by the FDA as the first pan-tumor companion diagnostic product. Its test coverage includes 324 genes and two molecular markers — MSI and TMB — that predict the efficacy of immune checkpoint inhibitors. It covers all solid tumors except sarcoma and directly corresponds to 17 FDA-approved targeted therapies. Unlike conventional single-marker detection techniques such as FISH, IHC, and multi-gene hotspot panels that can only identify one or two types of genetic abnormalities, FoundationOne CDx uses comprehensive next-generation sequencing technology to detect all four types of genetic abnormalities simultaneously: base substitutions, insertions and deletions, copy number variations, and rearrangements — making it significantly more accurate and comprehensive than traditional testing approaches.