Part of the problem, says Finn, is that whether or not the
cancer has spread to other organs, there is often more than
one tumor within the liver itself. Another problem is that
many of the risk factors—like hepatitis B and C, alcoholism,
and nonalcoholic steatohepatitis, a type of fatty liver disease—
result in cirrhosis, life-threatening scarring that occurs when
the liver tries to repair its own damaged tissue. “A cirrhotic
liver is a premalignant organ,” explains Finn. “It is bad soil.
So, if you take out the cancer, it’s likely to grow back.”
This diseased liver state must be factored into liver
cancer staging, survival statistics and treatment options.
A patient with a cancer that has not spread beyond the
liver could have such extensive liver disease that surgery
or other cancer treatments, including a liver transplant,
are not an option, says Finn. For this reason, the liver
cancer staging system also includes a measure of liver
function known as a Child-Pugh score, which assesses
the extent of liver disease.
When Gardea was diagnosed in 2013, Nexavar, which
was approved in 2007, was the only targeted therapy available for treating liver cancer. Last year, two new options
became available. In April 2017, the U.S. Food and Drug
Administration (FDA) expanded approval for the targeted
therapy Stivarga (regorafenib) to include HCC previously treated with Nexavar. And in September 2017, the
FDA granted accelerated approval to the immunotherapy
drug Opdivo (nivolumab) for some patients with HCC.
Other therapies—such as Mekinist (trametinib), already
A SHARED FEELING OF GOOD FORTUNE
approved to treat certain types of metastatic melanoma,
Zolinza (vorinostat), approved to treat cutaneous T-cell
lymphoma, and Cabometyx (cabozantinib), approved to
treat advanced kidney cancer and a type of metastatic
thyroid cancer—are being studied in liver cancer in clini-
cal trials. “There is still a lot of work to be done,” says
Finn, “but the future is exciting.”
Five years after her initial diagnosis, on a return trip to
Brazil, Baron learned her cancer had recurred. While there,
she had a second surgery; this time, the doctor removed
the entire right lobe of her liver. Today, a decade later, the
Laurel, Maryland, mother of two and chief marketing officer
of a Baltimore-based nonprofit continues to be involved in
efforts to bring more research attention and dollars to FLC.
Annually, she sees a liver surgeon at the Johns Hopkins
Hospital in Baltimore. “Every year it’s hard,” says Baron.
“But it also gives me a sense of purpose, and it’s always in my
mind to live with that sense of purpose.”
Gardea continues to be fortunate. He developed a second
tumor in his liver in 2013, but the surgery to remove it went
well. And when medication needed to cure his hepatitis C
infection became available, his insurance covered it. “I
feel pretty good,” he says, even though one of his tumors
appears to be growing again.
“During the time I’ve had this, I’ve had a few friends
who got the same thing and died. In six months, they were
gone,” he reflects. “I’m getting into my fifth year, and when
I ask my doctor what our plan is, he says, ‘I don’t plan on
you going anywhere for a long, long time.’” There’s no question, Gardea says, “I’m one of the lucky ones.”
SUE ROCHMAN is a contributing editor for Cancer Today.
In 2015, liver cancer was the fourth leading cause of cancer deaths throughout the world, after lung, colorectal and
stomach cancer. That year, 854,000 people were diagnosed with liver cancer worldwide, and 810,000 died of the disease.
A study published in the December 2017 JAMA Oncology found hepatitis B infection was responsible for about 265,000, or
33 percent, of liver cancer deaths. Christina Fitzmaurice, an oncologist at the University of Washington in Seattle who
led the study, notes that although the World Health Organization recommends hepatitis B vaccination for all newborns,
currently only 39 percent of countries have incorporated these recommendations into their vaccination programs. In some
countries in Southeast Asia, there are high rates of hepatitis B, and transmission often occurs from mother to child during
birth. Vaccinating the babies within 24 hours of birth can keep them from becoming infected with the virus, Fitzmaurice
says, but many babies are born without health care providers present, so the vaccine may not be on hand. —S.R.
AN INTERNATIONAL PERSPECTIVE