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Researchers at Mount Sinai School of Medicine in New York have found that sorafenib (Nexavar) helps patients with advanced liver cancer live about 44 percent longer compared with patients who did not receive the anti-cancer drug. The findings, published in the New England Journal of Medicine, is a significant advance in the management of liver cancer, which is the third cause of cancer death globally, often resulting in death within a year of diagnosis.
"This is the first time that we've had an effective systemic treatment for liver cancer," said Josep Llovet, MD, Director of Research in Liver Cancer at Mount Sinai School of Medicine in New York, and a Professor at the Barcelona Clinic Liver Cancer (BCLC) Group in Barcelona, Spain and lead author of the study. "Our findings demonstrated survival advantages that are both statistically significant and clinically meaningful."
Sorafenib, a tablet that is taken orally, is approved in the United States for treating a form of advanced kidney cancer, and is currently being evaluated in patients with other cancers. Some 40 percent of liver cancers (and up to 80 percent in Asia and sub-Saharan Africa) are diagnosed at an advanced stage. Therapy for advanced liver cancer may include surgery (if possible), radiation therapy and/or regional chemotherapy (delivered directly into the liver). However, no systemic treatment-anti-cancer medication that enters the bloodstream, either as an oral or intravenous medicine-has proven effective to date for advanced liver cancer.
Dr. Llovet and his associates examined overall survival and the time it took for cancer to grow among patients with previously untreated liver cancer who were randomly assigned to receive either 400 mg of sorafenib twice daily (299 patients) or a placebo (303 patients).
Patients who received sorafenib lived a median of 10.7 months compared with 7.9 months for those who received a placebo. Time to cancer progression was also significantly longer in the treatment group: 5.5 vs. 2.8 months. Due to the positive findings, the study was terminated early.
The incidence of adverse side effects was similar between the two groups (52 percent in the sorafenib group and 54 percent for placebo). The most common moderate to serious side effects were diarrhea (11 percent vs. 2 percent), skin reactions in the hands and feet (8 percent vs. 1 percent), fatigue (10 percent vs. 15 percent) and bleeding (6 percent vs. 9 percent).
About Cancer
Cancer (medical term: malignant neoplasm) is the general name for a group of more than 100 diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not. The branch of medicine concerned with the study, diagnosis, treatment, and prevention of cancer is oncology.
Cancer cells can spread to other parts of the body through the blood and lymph systems. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma. Cancer types can be grouped into broader categories. The main categories of cancer include:
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Carcinoma - a cancer which is derived from the lining cells, or epithelium, of an organ. There are 4 major types of epithelium in the body (Glandular, squamous, transitional, and pseudostratified). Some types are only found in a few select organs such as the lung (pseudostratified) or urinary bladder (transitional). Carcinomas can arise from any of these epithelial types. For example, breast carcinoma is most commonly derived from the lining cells of the milk producing glands. A carcinoma with a glandular growth pattern is an adenocarcinoma. Common adenocarcinomas include prostate, colon, and breast. A carcinoma with a growth pattern resembling the squamous lining cells is termed a squamous cell carcinoma. Common squamous cell carcinomas are found in the esophagus and skin. However, any of these organs may have either type of carcinoma arising from it, although these latter diagnoses are exceedingly rare.
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Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.
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Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
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Lymphoma - a cancer derived from the white blood cells that are present in the lymphoid tissues of the body. These sites most commonly include the lymph nodes and spleen. However, lymphomas may arise from any organ and body site.
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Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking, limiting time in the sun, being physically active, and eating a better diet. Half of all men and one-third of all women in the US will develop cancer during their lifetimes.
Although doctors often cannot explain why one person develops cancer and another does not, research shows that certain risk factors increase the chance that a person will develop cancer. Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or viruses, bacteria, and certain hormones. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Other common risk factors for cancer include:
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