Immune Combination Therapy Helps Patients With Advanced Liver Cancer Recover

Tung-Ping Poon (L), honorary professor in the Department of Surgery at the University of Hong Kong, founder and President of Hong Kong Liver and Gastrointestinal Cancer Foundation, and Cheung Foon Yu (R), honorary treasurer and clinical oncology specialist (Hong Kong Liver Cancer and Gastrointestinal Cancer Foundation provide), talk about Advanced Liver Cancer Finds Recovery Through Immune Combination Therapy, on Oct. 3, 2023. (Provided by Hong Kong Liver and Gastrointestinal Cancer Foundation)

Liver cancer is the third leading cancer killer in Hong Kong, with 1,447 deaths in 2021, accounting for 9.6 percent of all cancer-related deaths. Unfortunately, only one out of five patients is suitable for surgical resection treatment, and terminal patients are usually deemed unsuitable. However, there are advanced liver cancer patients in Hong Kong who successfully shrink their tumors after undergoing one year of immune combination therapy. They can then undergo resection surgery to ‘zero out’ the tumor.

According to the Hong Kong Liver and Gastrointestinal Cancer Foundation, tumor removal surgery is the first choice treatment for early to mid-stage liver cancer. Surgery is not suitable if the tumor is too large, if it has invaded major blood vessels, or if cancer cells have spread. Immunotherapy activates autoimmunity against cancer cells.

Liver Cancer Decreases After Immune Combination Therapy

Mr. Chang, approximately 60 years old, is a carrier of the hepatitis B virus, does not take antiviral drugs, and does not do regular screenings. At the beginning of 2021, he felt a hard lump in his upper abdomen. As many relatives around him had died of liver cancer, he thought there was little hope of curing it and ignored the pain. It was not until November of the same year that he sought medical treatment due to abdominal pain and found that he was diagnosed with advanced liver cancer.

At that time, Mr. Chang’s tumor in the right liver was 16 to 17 cm. There was internal metastasis; the tumor had invaded the right hepatic vein and inferior vena cava and metastasized to the epigastric lymph node. The liver cancer index was 82,200 ng/mL, indicating fourth-stage cancer (normal is less than 7 ng/mL).

The attending doctor once asserted that Mr. Chang only had up to half a year to live. At one point, Mr. Chang decided to give up treatment. Still, with the persuasion of his family and introduction from friends, he sought treatment from Ronnie Tung-Ping Poon, an honorary professor in the Department of Surgery at the University of Hong Kong, and Cheung Foon Yu, a clinical oncology specialist, to receive a new treatment plan for advanced liver cancer.

Mr. Chang first tried oral targeted therapy, but after three months of treatment, the effect was unsatisfactory; he switched to immune combination therapy in February 2022. He experienced little discomfort or side effects during the medication but occasionally felt tired. He could still live as usual during the treatment, continuing to hike with his friends. After 12 months, his condition improved significantly; the liver cancer index dropped to 1.8 ng/mL. The right liver tumor had reduced to 10 cm with only a small amount of activity around it. Other intrahepatic metastases, inferior vena cava tumors, and lymphoid metastases had completely disappeared, meaning he was in the second cancer stage.

Tumor ‘Cleared’ Through Surgical Removal

Mr. Chang underwent right liver resection surgery in March 2023 and recovered smoothly with normal liver function. The pathology report shows that the cancer cells have entirely disappeared, only peripheral inflammation reactions remained, which the doctor estimated as drug reactions. After the surgery, he continued using immune combination therapy to eliminate latent cancer cells completely. The current liver cancer index is less than 0.6 ng/mL. In early September, his tumor was completely controlled and ‘cleared’—his body was back to normal. The doctor expects that Mr. Chang can soon stop medication completely, but he needs to be reviewed regularly to monitor the condition.

Mr. Chang shares his experience with fellow liver cancer patients. Even when the diagnosis confirms that the cancer is advanced or has spread, do not give up and try different treatment options. There is always a glimmer of hope.

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The Foundation notes that while surgical resection is the preferred method for liver cancer treatment, it is only suitable for patients in the early to middle stages. Immune combination therapy combines Atezolizumab and Bevacizumab, also known as Avastin, which activates autoimmunity to fight against cancer cells. It is now a new direction for the first-line treatment of middle to advanced liver cancer that cannot be treated with surgical resection. Research and clinical treatment experience have confirmed that ‘immune combination therapy’ has the opportunity to achieve down-staging of liver cancer, thereby increasing the chance of surgery or other treatment options.