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Chemotherapy (chemo) is treatment with drugs to destroy cancer cells. Chemo may be an option for people whose liver cancer cannot be treated with surgery, has not responded to local therapies such as ablation or embolization, or when targeted therapy is no longer helpful.

Which chemotherapy drugs are used for liver cancer?

Unfortunately, most chemo drugs do not have a great effect on liver cancer. Recent advances have shown that a combination of drugs may be more helpful than using just a single chemo drug. But even these combinations of drugs shrink only a small number of tumors, and the responses often do not last long. And most studies show systemic chemo has not helped patients live longer.

The most common chemotherapy drugs for treating liver cancer include:

• Gemcitabine (Gemzar)
• Oxaliplatin (Eloxatin)
• Cisplatin
• Doxorubicin (pegylated liposomal doxorubicin)
• 5-fluorouracil (5-FU)
• Capecitabine (Xeloda)
• Mitoxantrone (Novantrone)

Sometimes, combinations of 2 or 3 of these drugs are used. GEMOX (gemcitabine plus oxaliplatin) is one option for people who are fairly healthy and may tolerate more than one drug. 5-FU based chemotherapy, for example with FOLFOX (5-FU, oxaliplatin and leucovorin), is another option for people with bad liver disease.

How is chemotherapy given?

You can get chemotherapy in different ways.

Systemic chemotherapy

Drugs are injected right into a vein (IV) or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body, possibly making this treatment useful for cancers that have spread to other parts of the body.

For IV chemo, a slightly larger and sturdier catheter is required in the vein system to administer chemo. They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing. Many different kinds of CVCs are available. The 2 most common types are the port and the PICC line. 

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Treatment for advanced liver cancer is based on how well it is working and what side effects you have.

Regional chemotherapy

Drugs are put right into an artery that leads to the part of the body with the tumor. This focuses the chemo on the cancer cells in that area. It reduces side effects by limiting the amount of drug reaching the rest of the body. Hepatic artery infusion, or chemo given directly into the hepatic artery, is regional chemotherapy that can be used for liver cancer.