Targeted and immunotherapy drugs for liver cancer
You might have 
or drugs for a type of primary liver cancer called hepatocellular carcinoma (HCC). The main targeted drugs and immunotherapy for HCC are:
- atezolizumab and bevacizumab
- sorafenib
- lenvatinib
- regorafenib
- cabozantinib
- durvalumab and tremelimumab
These drugs are treatments for liver cancer. Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.
What are targeted and immunotherapy 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 targeted or immunotherapy drugs for liver cancer
You might have targeted drugs or immunotherapy if surgery isn’t a suitable treatment for you. Or if it has spread to other parts of the body (advanced cancer). To have these drugs your liver must be working well.
Although these treatments can’t cure the cancer, they may help to control it for a time, reduce your symptoms and help you feel better. They can help some people to live longer.
Lines of treatment
You might hear the terms first, second and third line treatment. The first course of targeted or immunotherapy you have is the first line treatment. Your doctor might offer you second line treatment if first line treatment isn't working or your cancer starts to grow again.
Types of targeted and immunotherapy drugs for liver cancer
Atezolizumab (Tecentriq) and bevacizumab (Avastin)
Atezolizumab is a type of immunotherapy called a . Checkpoint inhibitors block proteins that stop the immune system from attacking cancer cells.
Bevacizumab is a type of targeted cancer drug. It works by stopping the cancer growing blood vessels. It may also help checkpoint inhibitors to work better.
This combination is a treatment option for people with HCC. You might have this if:
- your cancer is advanced or can't be removed with surgery
- you have not had any other systemic treatment for your cancer
- you are generally well enough to carry out your normal activities (
performance status of 0 or 1)
Sorafenib (Nexavar)
Sorafenib is a type of targeted drug called a cancer growth blocker. It 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
You might have sorafenib if you have advanced HCC. You might have it as a first or second line treatment.
Lenvatinib (Lenvima)
Lenvatinib is another type of cancer growth blocker. It works in a similar way to sorafenib.
You might have it as a first or second line treatment for HCC that is either:
- advanced
- unable to be removed with surgery (unresectable)
You need to be generally fit and healthy to have lenvatinib.
Regorafenib (Stivarga)
Regorafenib is also a cancer growth blocker. You have it after treatment with sorafenib (second or third line treatment).
It is used for people with advanced or unresectable HCC. To have regorafenib you have to be fairly fit and well.
Cabozantinib (Cabometyx)
Cabozantinib is another type of targeted cancer drug. It stops cancers from growing their own blood vessels. You might have this treatment if you have advanced cancer and sorafenib is no longer working.
Durvalumab (Imfinzi) and tremelimumab (Imjudo)
Durvalumab and tremelimumab are both types of checkpoint inhibitor. They block proteins that stop the immune system from attacking cancer cells.
You might have this combination if:
- your cancer is advanced or can’t be treated with surgery
- you haven’t had any other systemic treatments for your cancer
Durvalumab and tremelimumab is only available if you live in England or Wales.
How do you have immunotherapy or targeted cancer drugs?
You might have targeted drugs as a tablet or capsule. You have immunotherapy drugs into your bloodstream (intravenously) or as an injection under your skin (subcutaneously).
Tablets or capsules
You have sorafenib, lenvatinib, cabozantinib and regorafenib as 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, bevacizumab, durvalumab and tremelimumab through a thin short tube (a cannula) that goes into a vein in your arm.
Or you might have these drugs through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.
Injection under your skin
You might have atezolizumab as an injection under the skin (subcutaneous injection).
You usually have this into your thigh over a few minutes. You might have stinging or a dull ache for a short time after this type of injection. The skin in the area may go red and itchy for a while.
Side effects
The side effects of targeted and immunotherapy cancer drugs are different depending on the drug you’re having. Not everyone gets all side effects.
The side effects that you might 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 for liver cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you numbers to call if you have any problems at home.
Research into targeted and immunotherapy drugs for liver cancer
Researchers are looking at different types of targeted and immunotherapy drugs for liver cancer. Some of these are used to treat other cancers and some are new.
They are looking at these drugs on their own or combined with other treatments.
