Describe the purposes of the clinical trial and what researchers are trying to learn. Finding a clinical trial Research through clinical trials is ongoing for all types of cancer. Types of Cancer. Liver Cancer Guide. Net Guide Liver Cancer. Medical Illustrations. Risk Factors and Prevention. Symptoms and Signs. Types of Treatment. About Clinical Trials. Latest Research. Coping with Treatment.
Follow-Up Care. Questions to Ask the Health Care Team. Additional Resources. Before an experimental treatment can be tested on human subjects in a clinical trial, it must have shown benefit in laboratory testing or animal research studies. The most promising treatments are then moved into clinical trials, with the goal of identifying new ways to safely and effectively prevent, screen for, diagnose, or treat a disease.
Speak with your doctor about the ongoing progress of these trials, and to get the most up-to-date-information about new treatments. The American Liver Foundation receives contributions and funding from clinical trial and study sponsors but does not evaluate or endorse any clinical trials or studies, and is not affiliated with any of the sponsors. People take part in clinical trials for many reasons. When you volunteer to participate in a clinical trial, you help researchers learn more about curing, preventing, and treating liver disease and its complications, as well as improve healthcare for people in the future.
Bevacizumab is a targeted therapy that starves tumors by preventing new blood vessels from growing. Sorafenib is another targeted therapy that blocks the growth of blood vessels and cancer cells. Until now, the only treatments for HCC that have been approved since are no more effective than sorafenib, said Tim Greten, M.
The combination regimen will likely replace sorafenib as the standard initial treatment for some people with advanced HCC, Dr. Greten said.
Liver cancer is often diagnosed when it has already spread beyond the liver or is intertwined with many blood vessels, preventing it from being treated with surgery. With some more digging, scientists later found that high levels of a protein called VEGF may prevent immune checkpoint inhibitors from working. VEGF stimulates the growth of new blood vessels and also changes the number and type of immune system cells in and around tumors, Dr.
Finn explained. Because bevacizumab blocks VEGF, researchers from Genentech and several different medical centers tested atezolizumab with bevacizumab in a small study of people with liver cancer.
In , they reported that the combination was more effective than atezolizumab alone and had tolerable side effects.
The IMbrave trial is a follow-up to that earlier study. The IMbrave trial, sponsored by F. All participants had inoperable tumors and none had received whole-body systemic cancer treatment before.
Participants were randomly assigned to receive sorafenib or atezolizumab plus bevacizumab until the treatment stopped working or until the side effects became too harsh. By all measures, the combination treatment worked better than sorafenib.
The length of time that half of the patients in a treatment group are still alive, called median overall survival , is a key measure of how well a treatment works. The median overall survival was 13 months in the sorafenib group and longer in the combination group. The exact duration is still being determined for atezolizumab plus bevacizumab because most of the patients in that group are still alive, Dr. Greten noted. Patients who received the combination treatment also lived 3 months longer without their cancer getting worse or dying 7 months versus 4 months for sorafenib.
Kelley noted. Patients in both treatment groups reported that their quality of life got worse during the study period. Finn stressed. Many patients experienced side effects from the combination treatment. But overall, patients appeared to tolerate both drugs, Dr. There were similar rates of side effects and deaths due to side effects in the two groups. Bevacizumab can cause bleeding because of its effects on blood vessels, Dr. Greten explained. Liver cancer can also cause changes that heighten the risk of bleeding, such as low numbers of platelets , he added.
Finn said. Six percent of patients in both groups had serious bleeding events related to bevacizumab treatment. Patients may have to get routine tests to check for bleeding risk factors before taking the treatment, he suggested. Kelley wrote. Many ongoing studies of HCC are testing combinations of an immune checkpoint inhibitor and a drug that targets blood vessels, such as pembrolizumab Keytruda and lenvatinib, Dr.
Other studies are testing combinations of immune checkpoint inhibitors, Dr. But he and his colleagues are already thinking about how to continue to improve liver cancer treatment. Another future goal is to find biological markers biomarkers , like the level of a blood protein, that doctors can use to figure out which patients are most likely to respond to immune checkpoint inhibitors that are part of a combination treatment.
In general, immune checkpoint inhibitors are only effective for a fraction of patients with liver cancer. Greten is the codirector, is identifying biomarkers for immunotherapy. November 18, , by NCI Staff. It uses high voltage to open the "pores" of the cell like the pores of your skin which causes the cancer cells to die. It may be very useful for cancers that are in difficult areas to treat, such as near blood vessels.
New drugs have been developed that work differently from standard chemotherapy drugs. These new targeted drugs act on specific proteins in cancer cells or their surrounding environments. Tumor blood vessels are the target of several newer drugs. Liver tumors need new blood vessels to grow. The drug sorafenib Nexavar , which is already used for some liver cancers that can't be removed surgically, works in part by hindering new blood vessel growth.
This drug is now being studied for use earlier in the course of the disease, such as after surgery or trans-arterial chemoembolization TACE. Researchers are also studying whether combining it with chemotherapy may make it more effective.
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