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As researchers learn more about the changes in cells that cause cancer, they have been able to develop newer drugs that specifically target these changes. Targeted drugs work differently from standard chemotherapy drugs (which are described in Chemotherapy for Liver Cancer) and often have different side effects.

Like chemotherapy, these drugs enter the bloodstream and reach almost all areas of the body, which makes them potentially useful against cancers that have spread to distant parts of the body. Because standard chemo is not very effective in most patients with liver cancer, doctors are focusing more on using targeted therapies.

Kinase inhibitors

Kinases are proteins on or near the surface of a cell that carry important signals to the cell’s control center. Many of the targeted drugs used to treat liver cancer are kinase inhibitors. These drugs block several kinase proteins, which normally help tumor cells grow in one of two ways:

• Some kinases help tumor cells grow directly.
• Some kinases help tumors form the new blood vessels they need in order to get bigger (a process called angiogenesis).

Blocking these proteins can often help stop the growth of the cancer.

Sorafenib (Nexavar) and lenvatinib (Lenvima)

One of these drugs can be used as the first treatment for liver cancer if it cannot be treated by surgery or if it has spread to other organs.

Sorafenib is a pill taken twice daily. Lenvatinib is a pill that is taken once a day. 

Sorafenib may work better in people with liver cancer caused by hepatitis C.

Regorafenib (Stivarga) and cabozantinib (Cabometyx)

These drugs can be used to treat advanced liver cancer, typically if other treatments are no longer helpful.

Regorafenib is a pill, typically taken once a day for 3 weeks, followed by a week off. Cabozantinib is a pill taken once a day.

Side effects of kinase inhibitors

Common side effects of these drugs can include fatigue, loss of appetite, hand-foot syndrome (redness and irritation of the hands and feet), high blood pressure, weight loss, diarrhea, and abdominal (belly) pain.

Less common but more serious side effects can include problems with blood flow to the heart, bleeding, abnormal thyroid tests, and perforations (holes) in the stomach or intestines.

Monoclonal antibodies

Monoclonal antibodies are man-made versions of immune system proteins (antibodies) that are designed to attach to a specific target. The monoclonal antibodies used to treat liver cancer affect a tumor’s ability to form new blood vessels, which it needs to grow beyond a certain size. This new blood vessel growth is called angiogenesis, so these drugs are often referred to angiogenesis inhibitors.

Bevacizumab (Avastin)

Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form. This drug can be used along with the immunotherapy drug atezolizumab (Tecentriq) as the first treatment for liver cancer that cannot be treated by surgery or that has spread to other organs.

This drug is given as an infusion into a vein (IV), typically once every 3 weeks.

Ramucirumab (Cyramza)

Ramucirumab is a monoclonal antibody that targets a VEGF receptor (VEGFR) protein on cells, which can help stop the formation of new blood vessels. This drug can be used to treat advanced liver cancer, typically after another treatment stops working.

This drug is given as an infusion into a vein (IV), usually once every 2 weeks.

Side effects of angiogenesis inhibitors

Common side effects of these drugs can include:

• High blood pressure
• Tiredness (fatigue)
• Bleeding
• Low white blood cell counts (with increased risk of infections)
• Headaches
• Mouth sores
• Loss of appetite
• Diarrhea

Rare but possibly serious side effects can include blood clots, severe bleeding, holes (called perforations) in the stomach or intestines, heart problems, and slow wound healing.