Precision Treatment in Advanced Liver Cancer




Liver cancer, particularly hepatocellular carcinoma (HCC), remains one of the most challenging cancers to treat. While major advancements have been made in systemic therapies over the past decade, not all treatments work for every patient. This is where precision treatment comes in—a revolutionary approach that tailors therapy based on the unique characteristics of an individual's tumor.

The Shift Towards Personalized Medicine

For years, receptor tyrosine kinase (RTK) inhibitors like Sorafenib and Lenvatinib were the primary treatment options for advanced HCC. However, with the rise of immune checkpoint inhibitors (ICIs), treatments have become more effective. These new therapies, such as Atezolizumab + Bevacizumab, have shown significant improvements in patient survival.

Yet, despite these advancements, many patients develop resistance to treatments. Precision medicine aims to overcome this challenge by analyzing a patient’s tumor at the molecular level, allowing doctors to choose the best possible treatment.

How Precision Medicine Works in HCC

Using Biomarkers to Predict Treatment Response

Scientists have discovered several biomarkers that can indicate how well a patient will respond to certain drugs. For example:

  • Phospho-ERK (p-ERK) levels can predict sensitivity to Sorafenib.
  • FGF19 levels may indicate a better response to Lenvatinib.
  • Alpha-fetoprotein (AFP) can help determine the effectiveness of Cabozantinib and Ramucirumab.

Molecular Classification of Tumors

Liver cancer is not a single disease—different genetic mutations and tumor environments influence how a cancer grows. Researchers have classified HCC into different molecular subtypes, each with distinct drug responses. For example:

  • Proliferative tumors respond better to CDK4/6 inhibitors.
  • FGF19-driven tumors may benefit from FGFR inhibitors.

Understanding the Tumor Microenvironment (TME)

The TME consists of immune cells, blood vessels, and other factors that can impact how a tumor responds to treatment. Some tumors have a "hot" immune environment, making them more responsive to immunotherapy, while others are "cold" and require different strategies.

Future Directions in Precision Treatment

New Drug Technologies

Exciting new therapies are being developed, including:

  • PROTACs – A technology that degrades harmful cancer proteins.
  • Antibody-Drug Conjugates (ADCs) – Highly targeted drugs that kill cancer cells while sparing healthy ones.
  • mRNA Cancer Vaccines – Similar to COVID-19 vaccines, these train the immune system to fight cancer.

Functional Precision Medicine

Rather than relying only on genetic tests, doctors can now grow mini-tumors (organoids) in the lab from a patient's own cells to test different treatments before prescribing them.

While precision treatment is still in its early stages for HCC, it offers hope for more effective and personalized cancer care. As research progresses, doctors will be able to move away from a "one-size-fits-all" approach and towards therapies that give patients the best chance of survival.

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