Liver cancer: questions about subcutaneous immunotherapy

Hepatocellular carcinoma (HCC) is the most common form of liver cancer in adults, and accounts for approximately 90 percent of cancers that originate in the liver.

HCC is often associated with cirrhosis, damage and scarring to the liver. This includes cirrhosis caused by viral infections (hepatitis B or C), fatty liver diseases, and excess alcohol consumption. However, approximately 1 in 4 people with HCC have no history of these risk factors.

Immunotherapy has become an important treatment option for HCC, especially in cases where the cancer cannot be removed by surgery, and in cases where the cancer has spread outside the liver to other areas of the body. Immunotherapy refers to cancer treatments that help the body’s immune system identify and kill cancer cells.

Subcutaneous immunotherapy

In most cases, cancer immunotherapies are administered with an intravenous infusion, where a needle is inserted into a vein and the drug is delivered into the bloodstream. Subcutaneous immunotherapy is a new and emerging treatment option that’s being used to treat some cases of HCC (as well as several other types of cancers).

With subcutaneous immunotherapy, the immunotherapy drug is delivered into a layer of fatty tissue directly below the skin, called the subcutaneous layer. The subcutaneous layer is a useful route of administration for drugs, and it allows a drug to be absorbed into the lymphatic system, a network of vessels, lymph nodes, and organs that transport immune cells and remove unwanted substances from the body.

Subcutaneous immunotherapy may offer a few advantages, including shorter appointment times and greater flexibility about where injections can be administered. This may help make immunotherapy drugs more accessible to more people treating HCC and other cancers.

If you or a loved one is living with HCC and immunotherapy is a treatment option, it may be worth discussing subcutaneous immunotherapy with your healthcare team. With that in mind, here are some questions to help you get started.

What subcutaneous immunotherapy drugs are available?

Your first question will be whether the subcutaneous immunotherapy drugs that are available are a good fit for your diagnosis and treatment needs. Currently, there are only a few options for subcutaneous immunotherapy for HCC, but the number of options is expected to expand in the future.

What will an injection appointment be like?

A subcutaneous injection typically takes 3 to 7 minutes to administer, though the overall appointment will take longer. If you and your healthcare providers decide that subcutaneous immunotherapy is a treatment option, ask what the injection process is like, how long you can expect to be at an appointment, and any special instructions you need to follow before and after the appointment.

Where will the injections be administered?

Subcutaneous injections are typically administered to the abdomen or thigh, and specific drugs can only be injected at specific sites.

Where can you go for an injection appointment?

Subcutaneous immunotherapy offers more flexibility for appointment locations, and injections can be administered at a healthcare provider’s office. Injections do not require a visit to a hospital or infusion center.

What is the risk of side effects?

All cancer treatments cause side effects. The side effects will vary depending on the type of treatment, the specific drug being used, and in some cases, how that drug is administered. Fatigue, itching, cough, joint pain and muscle pain, and GI distress are common immunotherapy side effects, but your healthcare providers can explain the risk of side effects in greater detail. Your healthcare providers can also recommend medications and strategies to ease side effects.

Can this treatment affect liver function?

Immunotherapies and other cancer treatments can affect liver function and damage the liver. People with HCC often have liver damage or liver disease, and liver-related side effects require extra consideration when making treatment decisions. Ask your healthcare providers about liver-related side effects and monitoring liver function during treatment.

Are there contraindications or potential drug interactions?

Contraindications are health conditions that make a therapy potentially unsafe and inadvisable. Drug interactions are unintended effects that occur from taking two drugs simultaneously. Your healthcare providers should review your medical history, and they should have an up-to-date list of all medications you are taking (prescription, over-the-counter drugs, and supplements).

How can you expect to feel during and after an injection?

Ask your healthcare providers about how you can expect to feel immediately after an injection and in the days after. Ask if they have recommendations, such as having someone there to drive you home after the injection or taking a day off work.

How long will this part of treatment last?

Ask how long you will be taking the immunotherapy, what you can expect to feel like during this time, and any lifestyle adjustments you need to make—for example, precautions to prevent infections, and changes to diet and daily habits.

How often will treatments need to be administered?

The frequency of injections can vary from person to person. Ask your healthcare providers how often you will come in for injections. Also ask how often you will need to come in for checkups and exams, which will be needed to monitor your response to treatment, side effects, and liver function.

Preparing for your appointments

The questions above are intended as a starting point. Take time to think about what you want to know and write down a list of questions for your next appointment. It can also help to bring a loved one to your appointment, both as emotional support and to help you take notes.

Remember, your healthcare team will be your best source of information, and you are also an important source of information for your healthcare team. Knowing your concerns and questions can help your healthcare team provide you with better care.