Drug therapies 

If your primary liver cancer is not suitable for other treatments such as surgery, ablation or TACE, then drugs may be used.   

There are 2 types of drug therapy for liver cancer: Targeted therapy and Immunotherapy.  

Targeted therapy works by destroying cancer cells without harming healthy ones.  Immunotherapy works by using the body’s own immune system to recognise and fight cancer cells. In most people, immunotherapy will be the first drug treatment considered.   

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Immunotherapy  

Immunotherapy works in different ways to chemotherapy. In immunotherapy, immune checkpoint inhibitors block the signals on immune cells that stop the immune system from attacking the cancer cells. This lets the body’s own immune system recognise and destroy cancer cells. 

Targeted cancer drugs like angiogenesis inhibitors work by stopping the growth of new blood vessels which the cancer needs to grow and spread. This helps to stop the cancer developing a blood supply, which then slows or stops its growth.   

Often used in combination, these drugs can be a treatment option for people with hepatocellular carcinoma (HCC) that is advanced or metastatic (spread outside the liver) or can’t be removed with surgery. You might be offered this treatment if:  

• You have not had any other treatment for your cancer that circulates through the whole body (this is commonly referred to as systemic therapy)  

• Your liver is otherwise working normally   

• You are well enough to carry out all your normal daily activities, aside from heavy physical work   

• You have been checked for varices (veins in the oesophagus (food pipe) or stomach which can become large and may burst causing bleeding in the upper stomach or oesophagus). Any varices must have been treated within the last 6 months. You may have to have an endoscopy to check for varices before you start this treatment.  

There are several different immunotherapy combinations available. Your doctor will take many factors into consideration before recommending a specific treatment.   

How is immunotherapy given?   

Immunotherapy is given through a drip into your bloodstream. This is either through a small cannula in a vein in your arm or via a central line. A central line is a long, thin plastic tube that gives the drugs into a large vein either in your chest or your arm. It stays in while you have treatment.   

Each treatment may take 1–3 hours. Treatments are usually given every 3 or 4 weeks and your doctor will discuss with you how often and how many treatments will be needed.  

Treatment is usually continued for as long as it is working to keep the cancer under control. Treatment may be stopped, or changed to another treatment, if the tumour is progressing (getting bigger) on follow-up scans, if the cancer starts to grow in other places, or you have severe side effects.    

What are the side effects of immunotherapy?

 As each person is different, so too are the side effects each person may experience. The side-effects you may experience depends on  

• Which drug you have  

• Whether you have it alone or with other drugs  

• The amount (dose) of drug you have  

• Your general health  

Immunotherapy side effects usually happen when the immune system becomes overactive and starts affecting healthy organs, such as the skin, bowel, liver, or hormone-producing glands.  

Some side effects that may occur are:  

• Diarrhoea  

• Muscle soreness (called arthralgia)  

• Skin rash  

• Thyroid dysfunction  

• Problems with your pancreas – this can lead to diabetes  

• High blood pressure  

• Delayed wound healing  

Some rare, but serious side effects include:  

• Problems with your heart (called myocarditis)  

• Problems with your lungs (called pneumonitis)  

• Severe diarrhoea and blood in your stools (called colitis)  

• Inflammatory arthritis  

• Variceal bleeding – if you have varices that are not treated before you start some of these medications you may be at a higher risk of them bleeding. If you are coughing up blood, have a blood nose that won’t stop or have blood in your poo you must seek medical attention immediately  

• Severe skin rash and blisters, along with fever and a flu-like illness (this is called Stevens-Johnson Syndrome). Although rare, this is an extremely serious illness, and rapid medical attention is required.  

These immune-related side effects can appear during treatment or even weeks, months, or years later. It is  important to report any side effects—no matter how mild—to your doctor or nurse, even if you have already stopped having treatment Some side effects, such as increased protein in your urine or thyroid problems, are picked up in blood and urine tests before you have any physical symptoms, so it is really important to always have your blood tests as requested. If side effects are found early, they are more likely to be managed without you having to stop treatment.  

Many of the side effects can be managed effectively with medications. Sometimes your treatment may need to be withheld for a period of time, or stopped.  

It is very important to tell any healthcare providers that you see, including in the Emergency Department, that you are receiving, or previously received, immunotherapy.

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Targeted therapy  

Tyrosine Kinase Inhibitors (TKIs) are types of targeted drugs that stop the liver cancer from growing. They do this by stopping signals that tell cancer cells to grow and stopping cancer cells forming new blood vessels which they need to keep growing.   

You might be offered this treatment if:  

• Your liver is otherwise working normally   

•  You are able to carry out all your normal daily activities.  

• You have not had any previous treatment with the same type of medication  

• If you have contraindications to first line therapy  

How is targeted therapy given?

These medications are often taken as tablets or capsules. You must take these tablets and capsules according to the instructions your doctor or pharmacist gives you.  

What are the side effects of targeted therapy?

The side-effects of these drugs can include  

• Skin rash  

• A rash, itching or peeling of the skin on your hands and feet, called hand-foot skin reaction  

• Diarrhoea  

• Fatigue  

• High blood pressure   

• Loss of appetite and weight loss  

• Changes to other organs, such as thyroid problems   

• Changes to the voice such as hoarseness  

Your treatment team will closely monitor you while you are on targeted therapy, including regular blood tests. If the side effects become difficult to manage you may be able to reduce the dose or take a short break before restarting.  

Targeted therapy is usually continued as long as it remains effective, and you are not having severe side effects. If the liver cancer progresses despite treatment with drugs, your doctor may discuss other therapy options with you.  

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How much do drug therapies cost?  

If you are on oral therapy, you will pay the price of a normal PBS script. If you are having IV therapy in a public hospital you will not pay for the treatment. If you are having treatment in a private facility your private health cover may cover some or all of the costs. You should talk to your doctor about your best option.  

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Resources

Liver Foundation Nurse Led Support Line: call 1800 841 118 or email support@liver.org.au to talk to a friendly, expert hepatology nurse. 

Reviewed Jan 2026