At present, many large hospitals in China have carried out targeted therapy for cancer. It can be said that targeted therapy has entered a new era. Compared with more than ten years ago, targeted therapy is more popular, and patients are more concerned about targeted therapy. The demand is also greater and greater, so is targeted therapy really a panacea for cancer treatment? Today, we are talking about this topic for liver cancer.

When the mechanism of normal cells becoming cancerous and causing abnormal division and growth of cancer cells is gradually understood, the research of targeted therapy drugs has become the most important field of research and development of new cancer drugs. These drugs block the proliferation, spread and metastasis of cancer cells by attacking specific targets on cancer cells, and reduce the damage to normal cells, making the treatment of cancer patients more promising.

In clinical practice, targeted therapy drugs are often compared with traditional chemotherapy drugs. Chemotherapeutic drugs are often targeted at mechanisms of general cell growth regulation (eg, DNA synthesis, control of cell mitosis), and are therefore less specific for cancer cells.

The targets of targeted therapy drugs are molecules or enzymes related to the process of cell carcinogenesis, such as cell information transduction pathways related to abnormal proliferation of cancer cells or increased drug resistance, or the promotion of abnormal tumor angiogenesis and The regulation mechanism of cancer cell metastasis, etc. Through the inhibition of these abnormal mechanisms to achieve anti-cancer therapeutic effect. Therefore, the specificity of targeted therapy drugs is generally better than that of traditional chemotherapy drugs.

Is targeted therapy for liver cancer really effective?

For example, for example, the targeted therapy drug for liver cancer is Sorafenib. Sorafenib is a multi-kinase inhibitor that blocks the information transduction process related to the growth of cancer cells and vascular endothelial cells, and directly triggers the apoptosis of liver cancer cells, while inhibiting tumor angiogenesis, thereby reducing blood supply, and slow the growth of cancer cells.

In a previous large study, patients with advanced liver cancer who were inoperable or otherwise radically treated with sorafenib had an average survival of 10.7 months, compared with a median survival of 7.9 months for patients in the placebo control group. months, a significant increase of 2.8 months.

The same study of patients in the Asian region found that the average survival time of patients treated with sorafenib was 6.5 months, and the average survival time of patients receiving placebo was 4.2 months, which was also significantly longer. 2.3 months.

Both studies from a few years ago showed that sorafenib can indeed effectively prolong the survival time of patients with advanced liver cancer. Such therapeutic results are of course still a long way from eradicating tumors, but this is the first time in history that rigorous clinical trials have proven that for patients with hepatocellular carcinoma who cannot undergo surgery or other radical treatments, drug therapy can be used. Extend the survival time of patients. Also because of the success of sorafenib clinical trials, major pharmaceutical companies in the world have invested considerable resources in the research and development of new liver cancer drugs, and a variety of related drugs have subsequently appeared, such as lenvatinib, cabbo Tini, Regorafenib, Apatinib, etc., showing the effect of blooming a hundred flowers

How is targeted therapy different from traditional chemotherapy?

Many people think that the so-called targeted therapy only kills cancer cells without attacking normal cells, while traditional chemotherapy kills both good and bad cells. In fact, there are some conceptual misunderstandings, which are not entirely correct.

In fact, chemotherapy is not a target-free killing of good and bad cells. Many chemotherapy drugs have their mechanism of action and act on specific enzymes or molecules. It’s just that the target of chemotherapy is mostly related to cell proliferation, such as DNA structure, cell division, etc., so the specificity will be relatively poor, as long as it is a cell that proliferates faster in normal cells, such as hair, oral cavity or stomach. Cells that proliferate and divide on their own, such as mucosal mucosa and bone marrow hematopoietic cells, will become more sensitive and will be significantly affected.

Targeted therapy drugs, on the other hand, are looking for molecular enzymes related to the process of cell carcinogenesis, etc., including information transduction pathways, tumor-related angiogenesis, and factors related to the regulation of cancer cell metastasis, which are unlikely to appear in normal cells. According to the characteristics of cancer cells , the specificity of the drugs developed according to this target is relatively high, but it is not 100% that it will not affect normal cells, so targeted therapy will still have certain side effects.

Targeted therapy may be considered for advanced liver cancer

The use of targeted drugs is mostly in the advanced stage. The staging of hepatocellular carcinoma is based on the size and number of the tumor, whether it invades the hepatic portal vein or has metastases outside the liver, abnormal liver function caused by liver cirrhosis, and the patient’s physical condition. wait to distinguish.

The treatment of liver cancer can be broadly divided into two categories: radical treatment and palliative treatment.

Surgical resection, embolization, and liver transplantation are all radical treatments. For patients with early-stage liver cancer, these treatments that have the opportunity to radically cure the tumor should be given priority. Palliative treatments include arterial embolization and targeted drug therapy. If a patient with liver cancer is no longer suitable for radical treatment such as surgical resection, these treatments may be considered.

Generally speaking, liver cancer patients who cannot receive curative treatment can be divided into two categories:

The first category is due to poor liver function due to cirrhosis of the liver itself. If the number of tumors in such patients does not exceed 3 and the largest tumor does not exceed 3 cm, liver transplantation can be considered. However, because the source of liver donation is not easy, usually they can only retreat. Second, treatment methods such as vascular embolization or targeted therapy are used.

The second category is those whose liver function is still good, but cannot be resected due to too many tumors or metastases outside the liver , or even vascular embolization is not suitable, targeted therapy can be considered. Most of these two types of patients belong to intermediate and advanced liver cancer patients.

However, the use of targeted drugs is also being explored. Many medically developed countries may use targeted therapy earlier. Therefore, many new liver cancer drugs will be included in clinical trials of some liver cancer patients who are still in the mid-term. In Asian countries, due to the large number of patients with liver cancer, doctors have more experience in surgical techniques and local treatment, and have a more positive attitude towards treatment. Therefore, most of the targeted therapy methods are used in patients with severe conditions.

If the patient is suitable for surgery or other radical treatment, targeted therapy is not recommended in the first place. For patients in the mid-term, the difference between the effect of targeted therapy and other treatments is still being studied. As for whether targeted therapy as an adjuvant therapy after surgery can reduce the chance of tumor recurrence, it is also being studied, but many medical institutions are already doing this, and it is also effective.

For advanced liver cancer patients, although the combination of targeted therapy and traditional chemotherapy may increase the chance of controlling tumor growth, the combination of the two may also increase the side effects, so it is necessary to be very careful to evaluate and control the toxicity of the drug.

During use, the treatment status should be continuously tracked and evaluated

Targeted therapy is mostly oral. When using it, the dose must be adjusted according to the standard dose, the patient’s physical condition and the side effects that occur, and it should be taken until it is confirmed that there is no improvement in the condition.

From the past treatment experience, the use of a single targeted therapy drug to treat liver cancer has a low chance of significantly reducing the tumor volume. Its main effect is to slow tumor progression and prolong survival. Therefore, before using targeted therapy, if there is a period of follow-up observation, imaging tests (such as CT or MRI) and blood tests (such as alpha-fetoprotein) can be used to understand the growth rate of the tumor, and for subsequent evaluation of targeted The efficacy of the treatment will be more helpful. After starting use, it should be followed up regularly. The doctor will adjust the medication according to the patient’s condition and liver function, and use imaging tests and blood tests to evaluate the possible curative effect every 2 to 3 months.

The effect of targeted therapy on the quality of life of patients with liver cancer

The specificity of targeted therapy is high, but there may still be side effects, which are relatively common, including increased skin sensitivity on hands and feet, swelling or chapped blistering and other reactions, as well as skin rash, high blood pressure, diarrhea, weakness and fatigue. Therefore, although targeted therapy may prolong survival and slow tumor progression in patients with advanced liver cancer, there does not appear to be a significant improvement in subjective quality of life.

In addition, targeted therapy may also produce drug resistance. If the tumor growth is delayed for a period of time and then continues to grow after use, it can be assessed whether drug resistance has developed and whether to stop.

If the financial capacity permits, is the sooner the liver cancer patients use targeted therapy, the better the effect? Can it be used to replace traditional chemotherapy?

The sooner the targeted therapy is used, the better the effect. There is currently no empirical research to judge. The choice of targeted therapy and chemotherapy must be determined according to the patient’s condition, and there are no issues such as replacement and use.

Can liver cancer metastasize to other organs also be treated with targeted drugs?

yes. If the liver cancer has metastasized to other organs, or has invaded the hepatic portal vein, targeted therapy can also be tried.

Can targeted therapy cure liver cancer? If targeted therapy is also ineffective for advanced liver cancer patients, does it mean that there is no cure?

Targeted therapy cannot cure liver cancer. The results of the current study, only found to prolong the survival of patients with liver cancer. Patients with advanced liver cancer can consider targeted therapy. If targeted therapy is ineffective, physicians can evaluate whether there are other treatment options. Even if targeted therapy is used, there is not only one drug to choose from. It is still possible to discuss with physicians whether there is an opportunity to use chemical therapy. treat.

What should be paid attention to in daily life for patients receiving targeted therapy?

Regardless of whether targeted therapy is used or not, patients should pay attention to balanced nutrition and normal life and rest. In particular, it is best not to use healthy food or self-medication without authorization, so as not to affect the metabolism and effect of therapeutic drugs. If you want to use healthy food or other drugs, Be sure to discuss this with the attending physician in detail.