Immunotherapy and targeted cancer drugs

You might have an immunotherapy or targeted cancer drug for cancer that started in the liver (primary liver cancer). This might be because your cancer cannot be removed with surgery. Or it has spread to other parts of the body (advanced liver cancer). All of the drugs listed here are for a type of primary liver cancer called hepatocellular carcinoma (HCC).

What are immunotherapy and targeted drugs?

Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

Targeted drugs work by targeting the differences in cancer cells that help them to grow and survive. There are many different types of targeted drugs. You might hear some targeted drugs called biological therapies.

When you might have immunotherapy or targeted cancer drugs

You might have these drugs if your cancer cannot be removed with surgery. Or if it has spread to other parts of the body (advanced cancer). Although these treatments can’t cure the cancer, they may help to control it for a time and help some people to live longer.

Atezolizumab and bevacizumab

Atezolizumab is a type of immunotherapy called a checkpoint inhibitor. Checkpoint inhibitors block proteins that stop the immune system from attacking the cancer cells.

Bevacizumab is a type of targeted cancer drug. It works by stopping the cancer growing blood vessels.

This combination is a treatment option for people with HCC that is advanced or can’t be removed with surgery. You might have this if:

• you have not had any other treatment for your cancer that circulates through the whole body (systemic therapy)
• your liver is working normally (Child-Pugh class A)
• you are well enough to carry out all your normal activities, apart from heavy physical work (performance status of 0 or 1)

Sorafenib (Nexavar)

Sorafenib is a type of targeted drug called a cancer growth blocker. Sorafenib works in 2 ways. It stops:

• signals that tell cancer cells to grow
• cancer cells forming new blood vessels, which they need to keep growing

Doctors might use sorafenib for people with advanced HCC. To have this treatment your liver must be working normally.

Lenvatinib (Lenvima)

Lenvatinib works in a similar way to sorafenib but has some different side effects.

You might have it as a first treatment for HCC that is advanced or cannot be removed with surgery (unresectable). Your liver must be working normally and you have a performance status of 0 or 1.

Regorafenib (Stivarga)

Regorafenib is also a cancer growth blocker. You have regorafenib after treatment with sorafenib (as a second line treatment). This is also for people with HCC that is advanced or unresectable. As with Lenvatinib, you have to be fairly fit and well and your liver is working normally. 

Cabozantinib

Cabozantinib is another type of targeted cancer drug. It stops cancers from growing their own blood vessels. Your doctor may offer you this treatment if sorafenib is no longer working.

Your healthcare team can explain whether any of these drugs are suitable for you. Do ask any questions that you might have.

How do you have immunotherapy or targeted cancer drugs?

You have sorafenib, lenvatinib and regorafenib as tablets or capsules.

Tablets or capsules

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

Into the bloodstream

You have atezolizumab and bevacizumab as a drip into your bloodstream. This might be through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

Or you might have these drugs through a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Side effects

Everyone is different and the side effects vary from person to person. The side effects you have depend on: 

• which drug you have
• whether you have it alone or with other drugs
• the amount of drug you have (the dose)
• your general health

A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on. For more information about the side effects of your treatment, go to the individual drug pages.

When you go home

Treatment with these drugs can be difficult to cope with for some people. Your nurse will give you a number to call (advice line) if you have any problems at home.