Tamaki Hosokawa

TOKYO: As we navigate ourselves into the post-COVID-19 era, Japanese medical institutions are moving forward to treat more patients with hard-to-beat cancers with more cutting-edge treatments.

During the global COVID rage, fewer cancer-struck patients came to hospitals for health screening, often advancing their stage. A malignant lesion once surgically removable had grown into an unresectable tumor, or cancer had spread all over, leaving the patient very few options for survival.

As one of the most lethal cancers, a liver cancer diagnosis is often perceived as a death sentence, and its eradication has long been a dream for medical professionals. But now, new drugs can offer more survival outcomes to patients in a more advanced stage.

“I have seen liver cancer treatments and the 5-year survival rate improving slowly, but stably since I became a doctor 20 years ago,” said Dr. Junichi Shindoh, a surgeon-in-Chief at the Department of Gastroenterological Surgery at Toranomon Hospital in Tokyo. He is globally known for his specialty in the liver and pancreatic cancer.

Liver cancer mainly has two types; metastatic liver cancer, which occurs when cancer in other areas gets established in the liver, and Hepatocellular Carcinoma (referred to as HCC), which often develops due to severe liver damage as hepatitis or liver cirrhosis.

The treatments vary for each type: More options are available for the former since the liver has not experienced much damage and can take most pre-surgical drug therapies. But for HCC, much fewer options are available since the liver already has enough damage to the point where its restoring function cannot compensate for the side effects from chemotherapy.

The only desirable treatment for HCC, which remains the second major cause for cancer mortality, is surgery, but most HCC patients in the advanced stage, are no longer in scope for this option.

One of the hot topics to discuss is an emerging process called “conversion,” which attempts to “convert” inoperable tumors in size and numbers to shrink so patients can undergo surgery. The systemic treatment strategy, which combines Molecular Targeting drugs designed as a part of targeted agents to attack and stop cancer growth, and Immune Checkpoint Inhibitor (ICI), which promotes the immune response to kill cancer cells, is the new direction into the future.

“We could not see this becoming a reality just several years ago, although still on a smaller scale, we are seeing unresectable cases becoming more available for surgeries,” said the surgeon.

However, the most important practice for treating HCC is to maintain a healthy balance between the targeted therapy such as Sorafenib, an FDA-approved chemo-drug that is known to pose serious side-effects, and immune therapy from ICI, etc., to keep the liver condition in check.

Also, the recent studies show that the combination of Sorafenib, iron chelator to control the iron supply to cancer cells, and Molecular Targeting drug could open up a path to a more successful conversion. Such cases are promising, especially for liver metastasis patients whose restoring function is readily present to fight the negative effects of drugs.

Precision Medicine is another evolving area that is starting to demonstrate clinical impact for advanced HCC patients. Identifying lethal genes in a patient’s genetic trait to form certain cancer based on individual genetic performances can help locate the best treatment for the patient while accelerating the analysis process. Japanese IT company, Fujitsu, is developing a platform using AI technology with millions of clinical studies. However, according to Dr. Shindoh, this further requires an investigation.

“I still find it rare that precision medicine plays a breakthrough role in liver cancer treatment due to individual differences. I doubt we are at the level of utilizing matching genetic information to identify which drug can have the most effect on certain patients.”

Even with the slow but steady evolving landscape for treating liver cancer, preventive measures seem crucial. Although avoiding stress, alcohol and smoking can go a long way, getting it is still unknown. 

“No certain lifestyle or diet will prevent our cells from forming cancer,” says Dr. Shindoh, who recently published his first book about cancer treatment guidelines. “When it happens, the most important thing is to get a thorough analysis and work with the doctor(s) who can provide the legitimate treatments tailored to your specific situation.”