New hope for advanced liver cancer patients

Prof Pierce Chow (seated) and Dr Andrew Khor giving Madam Ang Seok Hong the good news that she is now free of liver cancer.
PHOTO: New hope for advanced liver cancer patients

SINGAPORE - A new drug is giving a dose of hope to late-stage liver cancer patients, having proved effective in a trial.

Called Yttrium-90, it has been shown to shrink tumours more quickly and could also cost less than the more commonly used Sorafenib, an advanced liver cancer medication.

The two drugs are undergoing head-to-head clinical trials to see which is better, at the Singapore General Hospital (SGH), National Cancer Centre Singapore, National University Hospital and Khoo Teck Puat Hospital.

Sorafenib, an oral drug that inhibits the growth of tumours, costs patients about $10,000 a month for the rest of their lives. Yttrium-90, which is injected into the tumours, costs $10,000 for one treatment. Most patients need one to two treatments.

The radiation from Yttrium- 90 kills off the cancerous tumour cells. It is used in hospitals such as Memorial Sloan Kettering Cancer Centre in the United States.

Studies in the West have also shown Yttrium-90 to be effective. But Professor Pierce Chow of SGH said liver cancers here are largely caused by hepatitis B while those in the West are caused by hepatitis C and alcohol, so studies need to be done to see if Yttrium-90 is as effective here.

An earlier study of the drug on 103 advanced liver cancer patients from 2008 to 2012 seem to indicate that it might work even better on Asians than Caucasians.

Results of the study were published online in April.

But Prof Chow said more studies are needed - hence the ongoing one comparing Yttrium-90 and Sorafenib, which involves cancer centres in other Asian countries as well. It has just started and will be recruiting patients well into next year.

Liver cancer is the third biggest cancer killer in Singapore after lung and colorectal cancers, accounting for more than 400 deaths here each year.

One reason for the high number of fatalities is that liver cancer has fewer symptoms, so most people tend to discover it late.

In the earlier study, Dr Andrew Khor, who just graduated from Duke-NUS Graduate Medical School and is waiting for his posting, found that 103 advanced liver cancer patients treated with Yttrium-90 lived several months longer than those who were not treated with the drug.

These patients either had several tumours or tumours that were too big, or too close to critical blood vessels, and thus could not be removed through surgery.

Liver cancer is classified into four stages, with stage A for cancer that can be surgically removed to stage D where it has spread beyond the liver.

Yttrium-90 is for patients with advanced cancer in stages B and C.

Of the 103 patients, those in stage B lived an average of 23.8 months, compared with eight months for those not taking Yttrium-90. Patients in stage C lived 11.8 months longer than those not on the drug, who survived only about four months.

One patient who had been treated with Yttrium-90, but was not part of the study, is Madam Ang Seok Hong. She was already suffering from late stage liver cancer when the tumours were discovered during a routine medical screening in April 2012.

The cancer was just starting to spread beyond the 54-year-old's liver where her doctors found four tumours - the largest of which was 14cm long, or about half the size of her liver.

Madam Ang, the administrative manager for her family- owned timber company, decided to go with Prof Chow's suggestion of trying Yttrium-90 as she was looking for "the best and safest method".

After Yttrium-90 was inserted - through the blood stream straight to the tumour in the liver using a catheter - the largest one shrank by half.

Prof Chow said the results were so promising that they did a second round some months later, which caused the same tumour to shrink to 4.9cm.

Not only did the tumour reduce in size, it also moved away from a critical blood vessel and made surgery possible.

This was done in April, and a check last month found Madam Ang cancer-free. Prof Chow said they will continue to monitor her in case the cancer recurs, as she is still a carrier of hepatitis B - a virus she inherited at birth.

Madam Ang's father had died of liver cancer. But with the hepatitis vaccine given to all children here at birth, all three of her children are free of it.

This article was first published on June 9, 2014. Get a copy of The Straits Times or go to for more stories.