Today is 'Liver Day'... Liver cancer, the leading cause of cancer death among ages 40-50, shows increased chances of cure with treatment advances

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[Asia Economy Reporter Kim Young-won] Every year on October 20th is 'Liver Day,' established by the Korean Association for the Study of the Liver. The liver is called the 'silent organ' because it shows no symptoms even when serious damage occurs, so active screening for early detection is necessary. Among all liver diseases, 'liver cancer' imposes the highest physical, economic, and social burden. Liver cancer has been found to be fatal particularly to the active 40s and 50s age group. According to the '2021 Cause of Death Statistics' released by Statistics Korea, liver cancer ranked first among cancer causes of death in people in their 40s and 50s.

Liver cancer is characterized by a distinct occurrence in patients with chronic liver disease compared to other cancers. It is known that the risk of liver cancer increases about 20 times when infected with hepatitis viruses. Cirrhosis, a fibrotic change in the liver caused by chronic inflammation that hardens cells, accompanies about 80% of all liver cancer patients, and the annual incidence of liver cancer among cirrhosis patients is approximately 1-5%.

Major symptoms of liver disease include fatigue, loss of appetite, and jaundice, but most cases are asymptomatic. When liver cancer develops in cirrhosis patients, sudden jaundice symptoms may appear or ascites may accumulate. Symptoms of liver cancer include pain in the upper right abdomen, palpable lumps, abdominal bloating, weight loss, severe fatigue, and indigestion. However, these symptoms mostly appear after the cancer has significantly progressed.

Sometimes cancer is detected during health checkups when there are no symptoms or only vague symptoms. Therefore, experts emphasize the importance of regular screening, especially early screening for high-risk groups. Professor Heo Jeong of the Department of Gastroenterology at Pusan National University Hospital said, "72% of liver cancer patients have hepatitis B virus as the cause, and hepatitis C virus and alcohol are also common causes of liver cancer," adding, "Although the causes are relatively clear, due to the asymptomatic progression, symptoms are often felt only after the disease has advanced considerably, and patients visit hospitals late, so early diagnosis in high-risk groups is very important."

Treatment plans for liver cancer are determined by comprehensively considering the degree of cancer progression, liver function, and overall physical condition. When liver function and overall condition are not very poor, curative treatments such as liver resection, liver transplantation, radiofrequency ablation, or ethanol injection are performed.

Liver resection is primarily considered when tumor removal is possible and liver function is sufficient. Liver transplantation is a treatment that can expect a good prognosis in early liver cancer cases with a single tumor 5 cm or smaller, or up to three tumors each 3 cm or smaller, without vascular invasion or extrahepatic metastasis. However, even after curative treatment, liver cancer recurs in about half of the patients.

In cases of multiple tumors or tumors with vascular invasion, which are considerably advanced liver cancers, non-curative therapies are used. About half of liver cancer patients have multiple tumors, vascular invasion, or impaired liver function. Therefore, surgery is difficult to prioritize, and the most commonly used treatment is transarterial chemoembolization (TACE). This method involves administering chemotherapy drugs into the artery supplying oxygen and nutrients to the liver tumor and blocking the blood vessel.

When there is lymph node metastasis, metastasis to other sites such as lungs or bones, or when multiple treatments have been ineffective, chemotherapy can be considered. For about ten years, 'targeted anticancer drugs' have been used in hepatocellular carcinoma chemotherapy. Unlike traditional cytotoxic chemotherapy, targeted anticancer drugs act by inhibiting the activity of biomolecules involved in cancer formation, thereby preventing proliferation, with minimal attack on normal cells. However, the response rate to chemotherapy and the range and effectiveness of treatment options have been limited.

Recently, 'immune checkpoint inhibitors' that improve chemotherapy response rates and survival by utilizing the human immune system to kill cancer cells have been developed and are in use. Immune checkpoint inhibitors do not attack the cancer directly but stimulate the immune system to enable immune cells to better attack cancer cells. Major global guidelines in the US and Europe, as well as the revised '2022 Hepatocellular Carcinoma Treatment Guidelines' from June, recommend immune checkpoint inhibitor combination therapy (Tecentriq-Abev combination therapy) as the first-line treatment for patients with unresectable liver cancer.

The Tecentriq-Abev combination therapy reduced the risk of death by about 40% compared to existing treatments in global clinical trials and showed the longest median overall survival (19.2 months) among treatments approved in Korea to date. Notably, about 8% of patients in the study achieved 'complete remission,' where tumors completely disappeared, raising hopes for a cure even in metastatic hepatocellular carcinoma.

Since May, the Tecentriq-Abev combination therapy for liver cancer has been covered by Korea's national health insurance. Previously, Tecentriq's insurance coverage was limited to second-line treatment for non-small cell lung cancer, urothelial carcinoma, and small cell lung cancer, but from May, coverage has expanded to include hepatocellular carcinoma. Consequently, the annual drug cost, which was about 66 million KRW before insurance coverage, has decreased to approximately 3.3 million KRW, significantly reducing the financial burden of treatment.

Professor Heo said, "Metastatic hepatocellular carcinoma was once considered a very hopeless cancer due to low survival rates, but with the emergence of the latest immune checkpoint inhibitor combination therapy that can even expect a cure in advanced hepatocellular carcinoma, the treatment landscape is changing," adding, "Since good prognosis can be expected when treatment is received while liver function and overall condition are good, regular screening and consistent, active treatment are important for the prevention and treatment of liver cancer and various liver diseases."

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