Liver Cancer
The incidence of liver cancer is increasing globally and the number of new cases and deaths are projected to increase further.1 With more than 900,000 new cases diagnosed every year, liver cancer is the sixth most common cancer worldwide.2
Over 470,000 new cases are diagnosed annually in China, Japan and South Korea, more than 87,000 in the EU, and about 42,000 in the United States.3 Men are significantly more affected overall than women.2
Liver cancer causes death more often than many other tumors, and patients are usually diagnosed with late-stage disease. It is the third leading cause of cancer-related death globally. Liver cancer accounts for approximately 830,000 deaths worldwide each year.4 Only around six percent of patients live for five years after diagnosis.5
An estimated 75-85% of liver cancers worldwide are HCC (hepatocellular carcinoma), making it the most common form of liver cancer.4
In the past 5 years, improved treatment has increased overall survival in patients with HCC, although survival rates in advanced stages remain low.6
Prevention and Detection
Learn more about Bayer’s collaboration with the Egyptian Ministry of Health and Population that is improving access to liver cancer screening, diagnosis and treatment for people across Egypt. This project is part of the Global Oncology Sustainability Initiative at Bayer, which is primarily focused on improving access to quality cancer care and outcomes for large, underserved communities in low- and middle-income countries that experience disparities in access.
Advice for patients
Each body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.
The main risk factors for HCC are chronic infection with hepatitis B or hepatitis C virus,4 which is regarded as a potential precursor of a tumor, as is cirrhosis of the liver, a pathological change in the liver tissue involving shrinkage. Two to three decades can pass before the carcinoma develops. There are additional risk factors that increase the likelihood of a tumor developing, such as excessive alcohol consumption. A common type of liver condition called nonalcoholic fatty liver disease (NAFLD), which is closely associated with obesity and diabetes, also may increase the risk of liver cancer.
NAFLD is the fastest growing cause of HCC in many parts of the world, including the USA and parts of Europe.7 The incidence of NAFLD-related HCC is projected to increase dramatically by 2030, with increases of 82%, 117% and 122% from 2016 in China, France and the USA, respectively.7
Symptoms usually do not occur until the disease has reached an advanced stage – and to some extent symptoms are relatively non-specific. They include loss of appetite and nausea, as well as pressure and pain in the upper abdomen.
The early detection of HCC is crucial for successful treatment, because the tumor can be surgically removed in early-stage disease. A blood test and an ultrasound examination can detect HCC. Computed tomography (CT) or magnetic resonance imaging (MRI) can then confirm a possible diagnosis and help detect the size, shape and location of the tumor, as well as potential metastases in advanced stages of the disease.
Treatment of liver cancer
Approximately 30% of patients diagnosed with HCC are eligible for therapies that have the potential to cure the cancer, such as resection or transplantation. However, in many cases, diagnoses are made when the disease has progressed past the point of surgical resection, called unresectable HCC (uHCC), and curative therapies are no longer feasible for patients.8
Recently, significant progress has been made in the treatment of uHCC. Multiple treatment options that have the potential to extend lives are now available - both for patients who are receiving drug treatment for the first time (first-line) and for those receiving further drug treatment after initial treatment has stopped working (second-line).9
Despite the availability of multiple options and expert guidelines recommending their use, many patients are not receiving second-line treatment, reducing their opportunity for improved survival.11
Immunotherapy combination approaches are for many patients the standard of care for first-line treatment, However less than 30% of patients respond to this approach and for the majority of those who do respond to treatment, their cancer will eventually relapse.10
This is particularly relevant for those patients who are no longer responding well to first-line treatment and still have adequate liver function to benefit from second-line treatment. In this context, one of the most pressing challenges for physicians currently, is the selection of the optimal sequence of second-line treatments.
Real-world evidence among a broad population of patients with uHCC, including those who have received immunotherapy, shows that second-line treatments, including tyrosine kinase inhibitors (TKIs), can extend patients’ lives and improve outcomes with a consistent safety profile.12
It is important for patients to talk to their healthcare team about all available second-line treatment options after their first-line treatment has stopped working, as well as any further treatment options beyond. This will help to ensure that they get optimal outcomes across all lines of therapy for advanced liver cancer.
Bayer Treatment for HCC
Bayer’s key drug for advanced liver cancer is a type of targeted therapy called a multi-tyrosine kinase inhibitor (TKI) that targets tumors and combats tumor growth in multiple different ways.
Used by physicians for the treatment of advanced HCC in many countries around the world including the U.S., countries of the EU, China and Japan, it is approved as a second-line treatment option proven to extend patients’ lives and improve treatment outcomes.13,14
Commitment to the liver cancer community
In 2007, Bayer introduced the first drug therapy approved by regulatory authorities for first-line treatment of patients with HCC. In the decade following, an important unmet need in HCC was to improve outcomes after disease progression on first-line treatment. Numerous other compounds failed to show survival benefit until 2017, when Bayer’s second liver cancer drug received regulatory approval for second-line treatment of HCC patients, after clinical trial results demonstrated that it extends patients’ lives. This breakthrough made it the first treatment for advanced liver cancer to be approved in the second-line setting.
Bayer remains committed to continuing research into new treatment options to improve survival for patients with HCC and to supporting the liver cancer patient community through providing education and resources to raise awareness and understanding of the disease.
Bayer is a founding member of the International Liver Cancer Association (ILCA) which is devoted to liver cancer research and prevention.
References
1 Singal AG, et al. J Hepatol 2020;72:250–261
2 World Health Organization: GLOBOCAN 2020. Cancer Incidence and Mortality Worldwide in 2020. https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf. Accessed October 2022
3 Cancer today. Iarc.fr. Accessed September 23, 2022. https://gco.iarc.fr/today/online-analysis-table?v=2020&mode=cancer&mode_population=continents&population=900&populations=392_410_160&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=0&include_nmsc_other=1
4 Sung, H, Ferlay, J, Siegel, RL, et. al. Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021: 71: 209- 249.
5 Chen JG, Zhu J, et. al. Liver Cancer Survival: A Real World Observation of 45 Years with 32,556 Cases. J Hepatocell Carcinoma.
6 Llovet, J.M., et al. Hepatocellular carcinoma. Nat Rev Dis Primers 7, 6 (2021). Available at : https://www.nature.com/articles/s41572-020-00240-3
7 Nat Rev Gastroenterol Hepatol, 2021. 18(4): p. 223-238.
8 Kanwal, F., Befeler, A., Chari, R.S., Marrero, J., Kahn, J., Afdhal, N., Morgan, T., Roberts, L., Mohanty, S.R., Schwartz, J., VanThiel, D., Li, J., Zeringue, A. and Di'Bisceglie, A. (2012), Potentially curative treatment in patients with hepatocellular cancer—results from the liver cancer research network. Aliment Pharmacol Ther, 36: 257-265. https://doi.org/10.1111/j.1365-2036.2012.05174.
9 Bouattour M, et al. Liver Cancer 2019;8:341–358 and EASL. J Hepatol 2018;69:182–236
10 Finn, Richard S., Qin, Shukui, Ikeda, Masafumi et al, Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma, New England Journal of Medicine 382, 20: 1894-1905, 2020. Available at : https://www.nejm.org/doi/full/10.1056/nejmoa1915745
11 O’Sullivan, D., Boyne, D., Syed, I. et al. Real-world treatment patterns, clinical outcomes, and health care resource utilization in advanced unresectable hepatocellular carcinoma. DOI: 10.1200/JCO.2022.40.4_suppl.400 Journal of Clinical Oncology 40, no. 4_suppl (February 01, 2022) 400-400. 2022. Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.4_suppl.400?af=R
12 Jun Kim. Y. et al. Poster presentation P-99. Presented at: International Liver Cancer Association 16th Annual Conference, September 1–4, 2022.
13 Stivarga (regorafenib) Full Prescribing Information, Bayer HealthCare Pharmaceuticals, Whippany, NJ, 2020.
14 Stivarga Investigators Brochure. Bayer HealthCare Pharmaceuticals. v17.0 Date: 25 Nov 2020.
