Immunotherapy helps support the immune system in attacking cancer cells and is a treatment option for liver cancer.

Immunotherapy drugs can alter how the immune system responds to cancer cells and enhance how it fights cancer.

This article looks at immunotherapy for liver cancer and other potential treatments.

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Immunotherapy is a medication that helps the immune system destroy cancer cells. The immune system identifies and destroys atypical cells, including cancer cells.

The immune system can help prevent or slow cancer cell growth. However, cancer cells may have certain features that make it more difficult for the immune system to destroy them, such as:

  • genetic changes to avoid immune system detection
  • proteins on the surface of cancer cells to turn off immune cells
  • altering cells around a tumor to affect immune system response

Immunotherapy is a biological therapy that uses substances that living organisms create.

Treatment for liver cancer may include types of immune checkpoint inhibitors. Immune cells have checkpoint proteins, which turn on or off to activate an immune response, so they can prevent the immune system from destroying healthy cells,

However, these checkpoints may prevent the immune system from destroying certain cancer cells, so immune checkpoint inhibitors block the action of the checkpoints. This increases the immune system’s response against cancer cells.

Learn more about how the immune system works.

PD-1 is a checkpoint protein on T cells, a type of immune cell. PD-L1 is a protein within typical cells and can also occur in higher amounts in some cancer cells.

PD-L1 controls and limits the immune response. PD-1 binds to PD-L1 and prevents T cells from attacking other cells, including cancer cells.

PD-1 and PD-L1 inhibitors attach to either of these proteins to prevent them from binding. This allows T cells to destroy cancer cells.

PD-1 and PD-L1 inhibitors may help reduce tumor size or slow the growth of cancer cells.

FDA-approved PD-1 and PD-L1 inhibitors

PD-L1 inhibitors with Food and Drug Administration (FDA) approval include atezolizumab (Tecentriq) and durvalumab (Imfinzi)

Doctors may use atezolizumab alongside bevacizumab, a targeted therapy drug, as a first-line treatment for liver cancer that surgery cannot treat or for liver metastases. The latter are cancerous tumors that spread to the liver from another part of the body.

Doctors may use durvalumab in combination with tremelimumab, another immunotherapy drug, as a first-line treatment for liver cancer that surgery cannot remove.

People may have PD-L1 inhibitors as an intravenous (IV) infusion every 2, 3, or 4 weeks.

FDA-approved PD-1 inhibitors include pembrolizumab (Keytruda) and nivolumab (Opdivo).

Doctors may use these PD-1 inhibitors for people with advanced liver cancer who have had previous treatment with sorafenib, a targeted therapy drug.

Doctors may use nivolumab in combination with ipilimumab, a CTLA-4 inhibitor.

People may also have PD-1 inhibitors as an intravenous (IV) infusion every 2, 3, 4, or 6 weeks.

CTLA-4 is a protein within T cells. It binds to a protein called B7 to prevent T cells from destroying other cells, including cancer cells.

CTLA-4 inhibitors block the CTLA-4 protein to prevent the protein from limiting the immune response. CTLA-4 inhibitors increase the ability of the T cells to destroy cancer cells.

FDA-approved CTLA-4 inhibitors

FDA-approved CTLA-4 inhibitors include ipilimumab (Yervoy) and tremelimumab (Imjudo).

Doctors may use tremelimumab in combination with durvalumab as a first-line treatment for liver cancer that surgery cannot remove. People may have this treatment as an IV infusion every 4 weeks.

Doctors may use ipilimumab in combination with nivolumab for liver cancer in people with previous drug treatment. People may have this treatment as IV infusion every 3 weeks for four treatments.

Possible side effects of checkpoint inhibitors include:

Other side effects of immunotherapy may include:

Other treatments for liver cancer may include:

  • Surgery: People may have surgery to remove the cancerous part of the liver. The remaining part of this organ may regrow.
  • Liver transplant: A surgeon removes the whole liver to replace it with a healthy donor liver.
  • Ablation therapy: Ablation therapy destroys cancerous tissue and may involve radio waves, microwaves, ethanol injection, electrical currents, or cryoablation to freeze cancer cells.
  • Embolization therapy: People may have embolization therapy if surgery cannot remove the tumor. This technique blocks blood flow to the tumor so it cannot grow.
  • Targeted therapy: Targeted therapy drugs specifically destroy certain cancer cells and minimize harm to surrounding healthy cells.
  • Radiation therapy: A machine sends high-energy radiation into the cancerous area to destroy cancer cells.

Read more about treatment options for liver cancer.

Below are answers to some common questions regarding immunotherapy for liver cancer.

What is the success rate of immunotherapy for liver cancer?

According to a 2023 review, immunotherapy can lead to long-term control of hepatocellular carcinoma (HCC) and increase survival rates while reducing side effects.

A 2020 study found that a combination of atezolizumab, a PD-L1 inhibitor, and bevacizumab, a targeted therapy drug, resulted in higher survival rates in people with unresectable HCC. This was in comparison with treatment with sorafenib, a targeted therapy drug.

Participants included 336 people receiving atezolizumab–bevacizumab and 165 receiving sorafenib. The overall survival rates at 12 months were 67.2% following treatment with atezolizumab–bevacizumab and 54.6% with sorafenib.

Treatment with atezolizumab-bevacizumab resulted in significantly improved survival and progression-free survival compared with sorafenib treatment.

Learn more about HCC liver cancer.

Does immunotherapy work on liver metastases?

Atezolizumab, in combination with bevacizumab, a targeted therapy drug, is a first-line treatment for liver cancer that has metastasized. This means it has spread to other parts of the body.

In a 2020 study of participants with locally advanced metastatic HCC, unresectable HCC, or both, treatment with atezolizumab and bevacizumab significantly improved survival rates and progression-free survival.

Immunotherapy supports the immune system in attacking cancer cells. Immune checkpoint inhibitors are a type of immunotherapy people may undergo to treat liver cancer.

Individuals may have immunotherapy in combination with other treatments, such as targeted therapy.