New twinning strategy tested to fight intermediate liver cancer
Nivolumab, which has been approved for use in other cancers, such as of the lung and skin, is an immunotherapy drug that enhances the body’s immune response against cancer cells. It is showing promising results for advanced liver cancer patients in ongoin
NEW TWINNING strategy is being tested to fight intermediate liver cancer.
When it comes to cancer, any treatment that offers better odds than an existing one is worth a try.
So a team that includes National Cancer Centre Singapore ( NCCS) and Singapore General Hospital ( SGH) is studying if pairing an existing treatment with a new immunotherapy drug, nivolumab, will benefit some liver patients.
For these patients, the cancer remains confi ned to the liver but has advanced to the point where surgery is no longer possible. The standard treatment for them is to administer yttrium90 ( Y90) radioembolisation.
This procedure involves injecting microspheres containing the radioactive Y90 element into the liver to kill the tumour cells. It has been able to control the growth of the cancer for a time in about 70 per cent of patients.
“We plan to study whether nivolumab can help to further enhance the efficacy of radioembolisation. If proven so, (the combination) will change the way we treat liver cancers,” said Dr Choo Su Pin,
Senior Consultant, Division of Medical Oncology, NCCS.
“With existing treatment of Y90 alone, patients with intermediate stage liver cancer may survive 15 to 18 months. By adding nivolumab, we are hoping to further enhance these survival rates,” she added.
Dr David Ng, Senior Consultant and Head, Department of Nuclear Medicine and PET, SGH, said: “Y90 radiation kills tumour cells which release antigens that stimulate or awaken the immune system. The addition of nivolumab causes these activated immune cells to recognise and attack the tumour cells as well.”
Nivolumab, which has been approved for use in other cancers, such as of the lung and skin, is an immunotherapy drug that enhances the body’s immune response against cancer cells. It is showing promising results for advanced liver cancer patients in ongoing studies, with early data showing that in a few cases, the cancer disappeared with treatment. The drug also managed to extend the life of patients with advanced cancer by 14.4 months, compared to 6.5 months under sorafenib, the current standard treatment.
When combined with radiation, nivolumab and other immunotherapy drugs have also been observed to cause an abscopal effect, meaning not only the treated tumour but growths in other parts of the body that were not exposed to radiation also shrank.
The trial, which also involves the Genome Institute of Singapore and the Singapore Immunology Network, began in December 2016 and is expected to end in 2018. It aims to recruit 40 eligible participants.
Liver cancer is common in Africa and Asia, with almost 80 per cent of cases in this region due to the hepatitis B virus. While a successful immunisation programme has lowered the incidence of liver cancer from hepatitis B in Singapore, the number of fatty liver associated liver cancer has been on the rise. Liver cancer is one of Singapore’s top killer cancers. • This story was first published in Singapore Health, Sep - Oct 2017 issue.