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As researchers learn more about the gene and protein changes inside cells that cause cancer, they have been able to develop newer drugs that specifically target some of these changes. Targeted drugs work differently from standard chemotherapy drugs and often have different side effects.

When are targeted drugs used for liver cancer?

Targeted drugs enter the bloodstream and reach almost all areas of the body, which can make them useful against cancers that have spread to distant parts of the body.

These drugs might be an option if liver cancer can’t be treated by surgery or if it has spread to other organs.

Kinase inhibitors to treat liver cancer

Kinases are proteins inside cells that normally help tumor cells grow in one of two ways:

• Some kinases help tumor cells grow.

• Some kinases help tumors form the new blood vessels they need in order to get bigger (a process called angiogenesis).

Many of the targeted drugs used to treat liver cancer are kinase inhibitors. These drugs block several kinase proteins. Blocking these proteins can often help stop the growth of the cancer.

These drugs are most often used after immunotherapy drugs have been tried.

Kinase inhibitors that can be used to treat liver cancer include:

• Sorafenib (Nexavar)
• Lenvatinib (Lenvima)
• Regorafenib (Stivarga)
• Cabozantinib (Cabometyx)

These medicines are pills, taken typically once or twice a day, depending on the drug.

Side effects of kinase inhibitors

Common side effects of these drugs can include:

• Fatigue
• Loss of appetite
• Hand-foot syndrome (redness and irritation of the hands and feet)
• Rash
• Hair loss
• High blood pressure
• Weight loss
• Diarrhea
• Abdominal (belly) pain

Less common but more serious side effects can include:

• Problems with blood flow to the heart
• Bleeding
• Blood clots
• Abnormal thyroid test results
• Damage to other organs (such as the liver or kidneys)
• Perforations (holes) in the stomach or intestines

Other side effects are also possible, depending on which drug you’re getting. Ask your cancer care team what you should look out for.

Monoclonal antibodies

Monoclonal antibodies are lab-made versions of immune system proteins (antibodies) that are designed to attach to a specific target.

The monoclonal antibodies used to treat liver cancer affect a tumor’s ability to form new blood vessels, which it needs to grow. This new blood vessel growth is called angiogenesis, so these drugs are often referred to as angiogenesis inhibitors.

Bevacizumab

Bevacizumab (Avastin and other brand names) is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form.

This drug can be used along with the immunotherapy drug atezolizumab (Tecentriq) as the first treatment for liver cancer that can’t be treated by surgery or that has spread to other organs.

This drug is given as an infusion into a vein (IV), typically once every 3 weeks.

Ramucirumab

Ramucirumab (Cyramza) is a monoclonal antibody that targets a VEGF receptor (VEGFR) protein on cells, which can help stop the formation of new blood vessels.

This drug can be used to treat advanced liver cancer, typically after other medicines have been tried.

This drug is given as an infusion into a vein (IV), usually once every 2 weeks.

Side effects of angiogenesis inhibitors

Common side effects of these drugs can include:

• High blood pressure
• Tiredness (fatigue)
• Bleeding
• Low white blood cell counts (with increased risk of infections)
• Headaches
• Mouth sores
• Loss of appetite
• Diarrhea

Less common but possibly serious side effects can include:

• Blood clots
• Severe bleeding
• Holes (perforations) in the stomach or intestines
• Heart problems
• Slow wound healing