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Friday, January 6, 2017
News Recap
Liver Cancer
I guess the subject no one really wants to talk about is liver cancer (HCC), but there were several news items this past week on liver cancer treatments and so I’m going to talk about them.
Hepatocellular carcinoma (HCC) is associated with poor prognosis, with around 12% survival at 5 years. Most patients are diagnosed at advanced stages, with tumor portal thrombosis, metastasis, or both (Barcelona Clinic Liver Classification [BCLC] stage C) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32480-1/abstract. Early liver cancer can be treated with TACE therapies which have much better success than the last line defences like sorafenib and regorafenib. TACE is an image-guided, non-surgical procedure that is used to treat malignant lesions in the liver. The procedure uses a catheter to deliver both chemotherapy medication and embolization materials into the blood vessels that lead to the tumor (http://www.massgeneral.org/imaging/services/procedure.aspx?id=2267.) Ablation is another alternative for small tumors (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078184/). And the combination of TACE and ablation is the most effective for early HCC (http://meetinglibrary.asco.org/record/120535/abstract).
This week the U.S. FDA granted priority review to regorafenib tablets as a second-line systemic treatment for patients with advanced hepatocellular carcinoma, for whom sorafenib wasn’t working (U.S.: FDA grants priority review to Stivarga for second-line treatment of HCC.) This new drug Stivarga (regorafenib) improved OS (overall survival) in patients with HCC who progressed during treatment with Nexavar (sorafenib), which is currently the last line of treatment for people with advanced liver cancer, but neither of these drugs can cure the cancer; they can only extend life by a few months to a year. And the side effects are horrid!
Interestingly, the effect of sorafenib on overall survival may depend on the hepatitis status of patients with advanced hepatocellular carcinoma (HCC), according to a study published in the Journal of Clinical Oncology. Patients who were both hepatitis B virus (HBV) negative and hepatitis C virus (HCV) positive had a lower risk of death than patients with other viral statuses. Still among patients who were HBV negative and HCV positive, median overall survival for those treated with sorafenib was 12.6 months compared with 10.2 months for patients treated with other agents, which included brivanib, sunitinib, and linifanib (Effect of Sorafenib on Overall Survival Dependent on Viral Status.)
Finally while cancer drugs approved between 2003 and 2013 often improved quality of life, the average overall survival increase was only 3.43 months, and many drugs reduced patient safety, according to an article published in JAMA Oncology. It is often unclear whether a particular cancer treatment is worth the costs associated with its development and distribution (Twenty Percent of New Cancer Treatments Do Not Offer a Clinical Benefit.)
Take Away Message: The most important thing is to get treated well before your liver progresses to stage 3 and 4 and the risk of liver cancer! How many times do we need to tell the governments to TREAT EVERYONE NOW! And if the news about liver cancer weren’t enough, yet another study shows that in spite of its name, the disease hepatitis C (“hepatitis” indicating inflammation of the liver), is a multiorgan disease affecting organs beyond the liver. Chronic hepatitis C virus has the potential to affect wide-ranging organ systems, including the kidneys, the skin, the hematological system, and even cause autoimmune disease and diabetes (Could Hepatitis C Damage Your Kidneys as Well?).