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Primary liver cancer is one of the most common malignant tumors in developing countries, seriously threatening people's lives and health. Treatment options include surgery, radiotherapy, radiofrequency ablation, venous embolization, and drug treatment. Chemotherapy alone has limited effectiveness in liver cancer since most liver cancer cells are not sensitive to chemotherapeutic drugs, meaning the side effects may outweigh the benefits for many patients.
Since 2007, sorafenib became the first targeted drug approved for liver cancer, breaking a long period with no effective medication for unresectable cases. It is recommended at 400 mg orally twice daily and is suitable for patients with Child-Pugh Class A or B liver function, with Class A patients showing more obvious survival benefits. In 2018, lenvatinib emerged as the second first-line targeted drug, proven non-inferior to sorafenib and showing better survival benefits in HBV-related liver cancer. It is dosed at 12 mg once daily for patients weighing 60 kg or more, and 8 mg once daily for those under 60 kg. For systemic chemotherapy, the FOLFOX4 protocol — combining fluorouracil, calcium folinate, and oxaliplatin — is approved in China for locally advanced and metastatic liver cancer not suitable for surgery or local treatment.
For patients whose liver cancer has progressed after sorafenib treatment, regorafenib is the approved second-line targeted option, dosed at 160 mg once daily for three weeks followed by one week off. In China, the initial dose can be gradually increased from 80 mg or 120 mg based on patient tolerance. Common adverse effects include hypertension, hand-foot skin reactions, fatigue, and diarrhea.
On the immunotherapy front, the US FDA has approved both Nivolumab and Pembrolizumab — PD-1 checkpoint inhibitors — for liver cancer patients who have progressed on or cannot tolerate sorafenib. These drugs work by unmasking cancer cells from the immune system, enabling the body's own defenses to recognize and eliminate them. Additionally, Chinese-developed immunological checkpoint inhibitors are currently undergoing clinical research, and combinations of immunotherapy with targeted drugs, chemotherapy, and topical treatments are being actively explored. Other approaches such as interferon α, thymosin α1, CAR-T cell therapy, and cytokine-induced killer cell therapy have also shown certain anti-tumor effects, though large-scale clinical validation is still ongoing
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About Sai Sree
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This article is for educational purposes only and should not replace medical advice, diagnosis, or treatment from a qualified oncology specialist. Every patient's case is different. Treatment decisions should always be made after a review of complete medical records by the treating medical team.
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