New two-pronged method to fight deadly liver cancer

By combining a 10-year-old treatment and one so new it is still being studied, doctors are hoping to help their patients better fight one of Singapore's top killer cancers.

They are taking this step because existing treatments often do not do enough to stop liver cancer, resulting in relatively high death rates.

A new liver cancer trial, which started last December, seeks to test the effectiveness of this two-pronged approach.

It is conducted by experts across four institutions, who aim to recruit 40 people for the trial.

The institutions involved are the National Cancer Centre Singapore (NCCS), Singapore General Hospital (SGH), the Genome Institute of Singapore and the Singapore Immunology Network.

An option for people with intermediate-stage liver cancer - meaning that surgery can no longer be done - is to undergo a treatment known as Y90 radioembolisation.

During this treatment, radiation is delivered directly to the tumour to kill cancer cells.

As these cells die, explained SGH's adjunct associate professor David Ng , it is believed that they release a substance that also stimulates the immune system.

"The immune cells then attack the tumour cells as well," said Prof Ng, who heads the hospital's department of nuclear medicine and positron emission tomography.

Even then, the immune system sometimes has trouble detecting the tumour cells.

This is where the new drug, known as nivolumab, comes in.

In the words of Dr Choo Su Pin, a senior consultant medical oncologist at the NCCS, it "wakes up" the immune system.

"Basically, your body recognises the cancer cells as bad, and eliminates them," she said.

Combining both treatments, she added, has shown promising results in treating other types of cancer, such as lung cancer.

Liver cancer is most common in Asia and Africa, and is often caused by the hepatitis B and C viruses or fatty liver disease.

In Singapore, it ranks among the top five causes of cancer deaths, with around 2,500 people dying of it between 2010 and 2014.

The new trial is open to people suitable for the Y90 radioembolisation treatment, or around 30 per cent of liver cancer patients.

Those who take part in the trial will first undergo the Y90 treatment.

Three weeks later, they will receive a dose of nivolumab every fortnight. They will be closely monitored throughout.


A version of this article appeared in the print edition of The Straits Times on February 03, 2017, with the headline 'New two-pronged method to fight deadly liver cancer'. Print Edition | Subscribe