Researchers from Japan are working on strategies to help those with primary liver cancer and moderate to severe cirrhosis.
Hepatocellular carcinoma is a deadly cancer, taking the lives of many patients within a year of being diagnosed. Although several breakthroughs in treatment have emerged recently, severe liver disease makes liver cancer that much harder to combat. Despite the generally poor prognosis, a new Japanese study demonstrates hope for hepatocellular carcinoma in those with concurrent, severe liver damage.
About Liver Cancer
Liver cancer can begin in the liver – primary liver cancer; or it can begin elsewhere and metastasize to the liver – secondary liver cancer. Worldwide, primary liver cancer affects twice as many men as women. As such, primary liver cancer is the most common type of cancer in males, mostly affecting people over 50. Hepatocellular carcinoma is by far the most frequently encountered type of primary liver cancer.
Leading causes of primary liver cancer include:
1. chronic infection with Hepatitis B
2. chronic infection with Hepatitis C
3. alcohol abuse
With any of these three types of liver disease, a progression of liver damage increasingly impairs the liver’s ability to function. As liver function progressively deteriorates, a greater likelihood of permanent liver scarring and abnormal liver cell growth exists. When liver cells grow abnormally and multiply, hepatocellular carcinoma tumors can form. It is understandable then that hepatocellular carcinoma is frequently seen in individuals with cirrhosis – permanent scarring of the liver. In fact, experts estimate that more than half of all people diagnosed with primary liver cancer also have cirrhosis.
Evaluating Liver Cirrhosis
Designated by the letters A, B or C, the Child-Pugh score, or the Child-Pugh grade, is frequently used by physicians to evaluate the prognosis of liver cirrhosis. With a rating of one to three, each of the following five variables is considered to calculate a Child-Pugh grade:
1. Severity of ascites
2. Severity of encephalopathy
3. Abnormality in serum bilirubin
4. Abnormality in serum albumin
5. Clotting (prothrombin) times
A Child-Pugh grade of “A” is the least severe, while “C” is the most severe and associated with the bleakest prognosis. As such, those with Class C are generally assumed to have a one-year survival rate around 50 percent, while someone with Class A or B is expected to have a five-year survival rate of 70 to 80 percent.
Treating Liver Cancer
When it comes to treating primary liver cancer, the drug Sorafenib (a multikinase inhibitor), has recently been established as the standard of care for patients with advanced hepatocellular carcinoma and a cirrhosis grade of Child–Pugh class A. This drug has been found to increase survival rate in those with the earliest staging of liver cirrhosis; however, Sorafenib’s safety and efficacy has not yet been determined in people with Child-Pugh class B or C.
A report of a small Japanese study published in an August 2011 edition of the New England Journal of Medicine gives a glimmer of hope for hepatocellular carcinoma in patients with moderate to severe cirrhosis. Takahiro Yamasaki and colleagues from Yamaguchi University Graduate School of Medicine in Ube, Japan evaluated Deferoxamine therapy in patients fitting this profile. Deferoxamine:
• is a cancer drug that has an anti-proliferative effect on tumor cells
• is an iron chelator
• stops the cancerous cell cycle by inducing apoptosis (cell death)
• prevented liver injury and the development of precancerous lesions in animal subjects
In their study, 90 percent of participants had either Hepatitis B or Hepatitis C infection – and 70 percent had either Child-Pugh grades of B or C. They found that the overall response rate to Deferoxamine was 20 percent – enough to warrant testing in patients with Child-Pugh class B or C and hepatocellular carcinoma.
While a 20 percent response rate for improving the prognosis of hepatocellular carcinoma may appear minor, it represents a bit of hope in the long-standing struggle to find better therapies for people with primary liver cancer.
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