Ghassan K. Abou-Alfa, MD: Immunotherapy is very complex but at the same time, to be fair, is very easy to understand. Just think about it this way: your immune system is like a car. You have a gas pedal and you have a brake pedal. And, if anything, the cancer cells, including liver cancer cells, have learned in your body how to put the brake on. In other words, we’re stepping on the brake all the time and not allowing the immune system to activate, and as such, we don’t have any new reaction to the cancer. And imagine now you bring in the drug that simply all it does is take off the foot from the brake and, as such, allows the new system to activate. And it’s exactly what happens in the checkpoint inhibitors, what we call autoimmune therapy. With this said, a certain activation of the immune system will ultimately lead to destruction of the cancer cells.
Liver cancer has many options of therapy nowadays. And if anything, immunotherapy is one that comes into a scenario where the patient has tried some other therapy, it did not work, so they go to the immunotherapy. The example that I gave is Opdivo, or nivolumab, based on the fact that it was approved by the FDA. But obviously, there are many other choices that are still under study.
Now the question is, would it mean that everybody should get that treatment? By definition, yes, but we have to be careful here, because those therapies are rather complex and they can cause certain problems. Remember that when you take off the foot from the brake of the immune system and let it fight against the cancer, that immune system can fight against everything in our body. As such, something as simple or as subtle as a certain rash when you get an immunotherapy, or as subtle as a diarrhea, it can translate into something bigger than that, including diabetes, including a problem with your thyroid, etc. Of course, listen very carefully to the patient and to the physician for a specific patient and see what they think in regard to the value of the immunotherapy in that regard.
Remember also, many patients with liver cancer can have an active infection of a virus called hepatitis B, or hepatitis C, or sometimes both together. A certain situation of the viruses might also limit the applicability of the use of the immunotherapy. Of course, as we always say, check with your doctor.