Targeted therapies have demonstrated significant efficacy and safety, greatly benefiting patients with liver cancer. These treatments not only help in controlling the disease and reducing tumor size but can also lead to complete remission in some cases through medication alone. Additionally, immunotherapy, particularly with immune checkpoint inhibitors (ICIs), has opened new possibilities for potentially curing cancer.

However, the correct use of these therapies is crucial. Incorrect usage can lead to unnecessary risks. Therefore, today we will discuss the key considerations and dietary precautions that liver cancer patients should be aware of when undergoing treatment with targeted drugs or immunotherapy.

01 Targeted Drugs

In the treatment of liver cancer, commonly used medications include Sorafenib, Lenvatinib, Donafenib, Regorafenib, Apatinib, as well as the combination therapy of Bevacizumab and Atezolizumab.

Drug Interaction Precautions:

(1)Sorafenib: When using Sorafenib, caution is advised when combining it with drugs metabolized or cleared via the UGT1A1 pathway, such as irinotecan, docetaxel, phenytoin, carbamazepine, phenobarbital, dexamethasone, and neomycin. Regular monitoring of INR values is essential when co-administered with warfarin .

(2)Regorafenib: Avoid combining Regorafenib with potent inhibitors or inducers of CYP3A4. Potent inducers include rifampicin, phenytoin, carbamazepine, and phenobarbital, while potent inhibitors include clarithromycin, ketoconazole, itraconazole, telithromycin, voriconazole, nefazodone, and posaconazole. Co-administration with irinotecan may increase systemic exposure to substrates of UGT1A1 and UGT1A9

(3)Apatinib: Similar to Regorafenib, Apatinib is also metabolized by the CYP3A4 enzyme system, sharing similar drug interaction concerns. However, Apatinib can cause QT interval prolongation on electrocardiograms, potentially affecting cardiac function. Therefore, patients should avoid drugs that prolong the QT interval and undergo close ECG monitoring during treatment.

Dietary taboos:

(1) Avoid Raw Seafood: Patients should avoid raw fish and shellfish, as these foods can carry parasites. Given that cancer patients undergoing targeted therapy often have compromised immune systems, they are at a higher risk of parasitic infections. It is advisable to minimize or avoid the consumption of such foods.

(2) Avoid Foods Containing CYP3A4 Inhibitors: Patients taking oral targeted therapies should avoid foods containing CYP3A4 inhibitors, such as grapefruit or any products containing grapefruit. Additionally, other foods like black mulberries, pomegranates, blackberries, starfruit, and parsley contain furanocoumarins, which can inhibit the activity of CYP3A4 enzymes in the liver and intestines. This inhibition can interfere with the metabolism of anticancer drugs and affect their efficacy in the body . Therefore, it is also recommended that liver cancer patients avoid these foods during treatment.

02 Immunotherapy drugs

Currently, the commonly used immune checkpoint inhibitors in the treatment of liver cancer include Atezolizumab, Sintilimab, Camrelizumab, and Tislelizumab

Drug Interaction Precautions:

Atezolizumab, Tislelizumab, and Camrelizumab: Patients should avoid the use of systemic corticosteroids or other immunosuppressive agents prior to starting these therapies, as these medications can interfere with the pharmacodynamic activity and effectiveness of the immune checkpoint inhibitors.
Sintilimab: It is recommended to avoid the use of corticosteroids, other immunosuppressive agents, or antibiotics for at least 30 days before initiating treatment with Sintilimab .
Impact of Antibiotics During Immunotherapy:Research has shown that the use of antibiotics during immunotherapy can significantly shorten patient survival times. Antibiotics can reduce gut microbiota diversity, which in turn alters T-cell responses, thereby diminishing the efficacy of immune checkpoint inhibitors (ICIs) in liver cancer patients.

Dietary taboos:

During immunotherapy, patients with liver cancer should avoid eating foods that are difficult to digest, hard, have too coarse fiber and are high in fat.

Strongly stimulating foods, such as those that are too spicy, too cold, too hot, or foods that the patient may be allergic to, are also best avoided.

03 Pain-relieving drugs

Commonly used painkillers include opioids (morphine, fentanyl, tramadol), local anesthetics (bupivacaine, ropivacaine), and NSAIDs (parecoxib sodium, flurbiprofen axetil), etc.

Drug contraindications:

(1) Contraindicated in patients with respiratory depression, craniocerebral injury, bronchial asthma, and moderate to severe liver or kidney dysfunction;

(2) Avoid taking painkillers on an empty stomach [7], as it may cause symptoms such as stomach discomfort, indigestion and upper gastrointestinal bleeding. It is recommended that patients take it after meals to minimize irritation to the gastrointestinal tract as much as possible.

Other precautions:

When pain control is not well controlled with one opioid, using another opioid may be beneficial, but it should be noted that several painkillers should not be taken simultaneously ;

(2) It is not recommended to take painkillers on your own. They should be used under the guidance of a doctor and strictly follow the doctor’s advice to use the medicine reasonably. Regular gastrointestinal risk assessment is also required.

(3) For patients who have been using high doses of opioids for a long time, the dosage must be gradually reduced to avoid withdrawal symptoms [8].

(4) The use of painkillers can also cause side effects, including persistent drowsiness, listlessness, weakness, nausea, constipation, etc. Patients with liver cancer should pay attention to following the doctor’s advice and reading the drug instructions before taking medicine. Pay attention to preventing falls and injuries caused by the influence of drugs in daily life.

Dietary taboos:

Avoid drinking tea before and after taking painkillers, as the tannic acid in tea will break down into tannic acid in the body and reduce the efficacy of the medicine when combined with it.

04 Antibiotic drugs

Anti-tumor antibiotics are a class of chemical substances with anti-tumor activity produced by microorganisms. Epirubicin, doxorubicin, and bicamycin all belong to anti-tumor antibiotics.

Contraindications for drug combination:

(1) Patients need to take their medicine on time and must not stop taking it at will. Even if the medicine takes effect, they should take it for a sufficient period under the guidance of a doctor.

(2) Pay attention to avoiding combination with multiple drugs. If one antibiotic can solve the problem, do not use two. The abuse of antibiotics is strictly prohibited.

(3) Do not purchase or take antibiotics on your own. If you need to use them, you should be examined and judged by a professional doctor and then choose the appropriate medicine

Dietary taboos:

During the medication period, avoid consuming large amounts of fat. Studies have shown that a high-fat diet combined with antibiotics will increase the risk of enteritis.

Medication tips:

Quit smoking and limit alcohol intake. Both tobacco and alcohol are carcinogens, which increase the risk of cancer cell development and metastasis, leading to a shortened survival period. Among them, alcohol can increase the toxicity of drugs and cause damage to the liver and kidneys. It is not recommended for liver cancer patients to drink alcohol or consume beverages containing alcohol.

(2) Do not take medicine with milk or tea.

(3) Avoid eating foods that are stimulating, greasy, spicy, spoiled, sour, moldy, grilled, smoked, or contain artificial colors or flavorings.