Immunotherapy provides ray of hope for liver cancer patients
Published on: Saturday, July 31, 2021
By: Bernama
.jpg "Immunotherapy provides ray of hope for liver cancer patients")
Kuala Lumpur: Globocan, an online database providing global cancer statistics, has estimated that 905,677 people worldwide were diagnosed with liver cancer in 2020. But more shockingly, 830,180 people around the world died from the disease last year, making it the third deadliest cancer globally.Hepatocellular carcinoma (HCC) is the most common primary liver cancer, which develops in patients with long-standing chronic liver diseases.
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In Malaysia, HCC is the sixth most common cancer and is the third leading cause of cancer deaths. Last year alone, a total of 2,149 new HCC cases and 2,050 deaths related to HCC were reported in this country.
Hepatitis B is the commonest cause of HCC in Malaysia, followed by fatty liver disease, also known as metabolic associated fatty liver disease which affects one in four Malaysian adults.
Although liver cancer is the third leading cause of cancer deaths in Malaysia, it is not as heavily discussed as other cancers, hence the need to improve public awareness and encourage Malaysians to get screened for liver cancer.
Clinical oncologist at the Faculty of Medicine, Universiti Malaya, Dr Wan Zamaniah Wan Ishak (pic) explained that there are too many misconceptions regarding this cancer, one of them being “healthy carriers” of Hepatitis B will not progress to cirrhosis or liver cancer. In fact, she added, the term “healthy carrier” is a misnomer.
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She said most Hepatitis B transmissions in Asia occur primarily at birth from an infected mother. However, infections and consequently, potential risk of liver cancer later in life, can be successfully prevented by giving newborns the Hepatitis B vaccination.
“Another common misconception is that fatty liver is a benign liver disease and will not develop into liver cancer. Regardless of the cause – whether it is Hepatitis B, Hepatitis C, fat or alcohol – liver damage progresses in a similar manner. The long-standing liver injury will cause fibrosis or scarring, resulting in advanced fibrosis and cirrhosis, predisposing to liver cancer,” she said.
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Dr Wan Zamaniah also noted that liver cancer is a complex disease involving the coexistence of two life-threatening conditions. In addition to the cancer, up to 90 percent of HCC cases have underlying cirrhosis (liver scarring), whereby the whole liver has been replaced by scar tissue.
She said a study carried out by Universiti Malaya Medical Centre (UMMC) in 2015 found out that the average age of HCC patients was 61 and 80 percent of them were men. Five in six HCC patients are diagnosed at an advanced stage of cancer or cirrhosis, so they are unable to receive curative treatment.
“Unfortunately, those presenting with symptoms related to either advanced cancer or underlying liver disease will typically not survive beyond six months of a liver cancer diagnosis. Therefore, early liver cancer detection using liver ultrasound for those at high risk of developing HCC is crucial to improve survival,” she said.
Consultant hepatologist at Faculty of Medicine, Universiti Malaya, Prof Dr Rosmawati Mohamed said while there are no definitive causes for the gender disparity in HCC patients, it can be suggested that reduced adiponectin (a hormone secreted by fat cells that helps to control the body’s metabolism) secretion in males during puberty may be responsible for the higher liver cancer risk in males.
She also said that the male liver is also less well equipped to cope with the chronic inflammation induced by certain infectious agents, such as acute toxins and other stressors.
“Although not fully understood until now, the differences in sex distribution are thought to be due to variations in hepatitis carrier states, exposure to environmental toxins, and/or potentially protective effects of estrogen mediated through inhibition of interleukin.
“With that being said, behavioural risk factors such as smoking and alcohol are known to be independent risk factors for HCC. Depending on the individual’s habits, it may lead to an increased incidence and mortality of HCC,” she added.
But all is not lost for HCC patients as they have the option of undergoing immunotherapy, one of the latest advancements in cancer treatment which allows the immune system to recognise the cancer cells and attack them.
As Dr Rosmawati pointed out, immunotherapy is, in general, effective across a wide variety of cancers, including HCC, and offers the possibility for long-term cancer remission. It can significantly reduce the risk of death and the risk of liver cancer progression.
Since immunotherapy is still relatively new, it is important that healthcare practitioners educate patients on all the available treatment options so that they can make informed choices for their cancer treatment.
“Immunotherapy is available in most hospitals with oncology services. Even if the cost varies, there are various financial aids, clinical programmes and resources that can lighten the financial burden for cancer patients.
“Ultimately, it is our aspiration as doctors to increase patient access to more treatment options in order to improve their cancer outcomes and quality of life,” said Dr Rosmawati.
Immunotherapy has been shown to work synergistically with other cancer treatments like radiotherapy and chemotherapy. While some cancers are more immunogenic than others, immunotherapy is generally effective across a wide variety of cancers.
“As immunotherapy can train the immune system to remember cancer cells, developing an “immunomemory” offers the possibility for long-term cancer remission,” explained Dr Rosmawati, adding that there are different types of immunotherapy that work in different ways to fight cancer cells.
“Some treatments help the immune system to stop or slow down cancer cell growth, while others help the immune system to destroy cancer cells or stop the cancer from spreading to other parts of the body.”
Pointing to common cancer treatments such as chemotherapy and radiation therapy (radiotherapy), she said the former destroys the rapidly-growing cancer cells in the body while the latter uses high doses of radiation to kill cancer cells and shrink tumours.Stay up-to-date by following Daily Express’s Telegram channel.
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