IMPORTANT SAFETY INFORMATION

NEXAVAR may cause birth defects or death of an unborn baby. Avoid becoming pregnant while taking NEXAVAR and for at least 2 weeks after stopping your treatment. Men and women should use birth control during and at least 2 weeks after NEXAVAR therapy. Call your doctor right away if you become pregnant. Do not breastfeed while taking NEXAVAR as this medication may be passed through breast milk. Before starting NEXAVAR, tell your doctor if you have allergies; heart problems or chest pain; bleeding or bruising problems. continue reading below »

Treatment Options for Liver Cancer

Your treatment plan will be based on the type of liver cancer you have, the stage of the cancer, how well your liver works, your overall health, and the discussion between you and your doctor.

There are 2 types of treatment used for liver cancer—curative treatment and noncurative treatment:

Curative treatment aims to cure the disease by removing the liver cancer. Curative treatments include:
- Liver transplant—may be possible if the cancer has not spread to other parts of the body and a compatible liver is found¹
- Surgery—can be used to remove 1 or more tumors, depending on the size and location within the liver²
Noncurative care is used for patients with unresectable disease (cancer that cannot be treated with surgery). The goal of this type of treatment is to make symptoms better and keep the cancer from getting worse for as long as possible. Noncurative care includes:
- Ablation therapy destroys the part of the liver where the tumor is. There are several types^3,4:
  - Percutaneous ethanol injection—destroys tumors by injecting them with a form of alcohol (ethanol)
  - Radiofrequency ablation—kills liver tumors by heating them to high temperatures with microwave probes
  - Transarterial chemoembolization (known as TACE)—a procedure in which chemotherapy drugs are injected into the blood vessels that feed the tumors. This delivers a high dose of chemotherapy to the tumor while lowering the blood supply that feeds the tumor
- Radiotherapy uses high-energy radiation to kill cancer cells and shrink tumors. There are 2 types of radiotherapy⁴:
  - External beam radiation therapy—uses a machine outside the body to deliver the radiation
  - Internal radiation therapy—uses a radioactive substance, such as yttrium-90, that is injected near a liver tumor
- Systemic treatment is a prescription medication taken by mouth that interferes with the signals in the body that cause normal and cancer cells to grow and multiply

For patients with liver cancer, a treatment plan may include any or all of the treatments above. Speak with your doctor about how Nexavar, an oral medication that is believed to inhibit the signaling processes in cancer cells, might fit into your treatment plan.

There are risks and benefits associated with all treatments. No two people respond to treatment the same way. You may feel few side effects, while someone else may have symptoms that require treatment or dosing changes.

Talk to your doctor about the side effects that you may experience with your treatment. Being prepared may help you to manage or possibly prevent side effects. It is important to promptly tell your health care team about any side effects you experience from treatment so that they may help you manage them.

Indication

NEXAVAR is an anticancer medicine used to treat a certain type of kidney cancer called advanced renal cell carcinoma (RCC), or a certain type of liver cancer known as hepatocellular carcinoma (HCC), when it cannot be treated with surgery.

Important Safety Information

Do not take Nexavar if you have a specific type of lung cancer (squamous cell) and receive carboplatin and paclitaxel. Before starting NEXAVAR, tell your doctor if you have: allergies; heart problems (including a problem called congenital long QT syndrome) or chest pain; bleeding or bruising problems; high blood pressure; or kidney or liver problems. NEXAVAR may interact with certain other medicines so tell your doctor about all medicines you take including prescription and over-the-counter (OTC) medicines, vitamins, or herbal supplements. It is especially important to tell your doctor if you take warfarin (Coumadin).

NEXAVAR may cause serious side effects, including:

– decreased blood flow to the heart and heart attack. Get emergency help if you have chest pain, shortness of breath, feel lightheaded or faint, have nausea or vomiting, or you are sweating a lot.
– bleeding problems. Tell your doctor if you have any bleeding or easy bruising while taking NEXAVAR.
– high blood pressure. Your blood pressure should be checked every week during the first 6 weeks of starting therapy and then regularly, thereafter. If your blood pressure is high, it may need to be treated.
– a skin problem called hand-foot skin reaction. This causes redness, pain, swelling or blisters on the palms of your hands and soles of your feet. Your doctor may change your dose or stop treatment for a while.
– perforation of the bowel. Tell your doctor right away if you get high fever, nausea, vomiting or abdominal pain.
– wound healing problems. If you have a surgical or dental procedure, tell your doctor you are taking NEXAVAR. Your treatment may be stopped until after your surgery or until your wound heals.
– changes in the electrical activity of your heart called QT prolongation. QT prolongation can cause irregular heartbeats that can be life-threatening. Tell your doctor right away if you feel faint, lightheaded, dizzy, or feel your heart beating irregularly or fast while taking Nexavar.

The most common side effects with NEXAVAR may include: rash, redness, itching or peeling skin; hair thinning or loss; diarrhea; nausea/vomiting; mouth sores; weakness; loss of appetite; numbness, tingling or pain in hands and feet; abdominal pain; tiredness; or weight loss. Tell your doctor if you have any side effects that bother you or do not go away.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1.800.FDA.1088. For important risk and use information, please see the patient prescribing information.

References: 1. National Comprehensive Cancer Network, Inc. The NCCN Clinical Practice Guidelines in Oncology™. Hepatobiliary Cancers (Version 2.2009). NCCN Web site. http://www.nccn.org. Accessed July 24, 2009. 2. The Wellness Community. Liver Cancer. Frankly Speaking About Cancer Spotlight Series. Washington, DC: The Wellness Community; 2009. 3. Llovet JM. Updated treatment approach to hepatocellular carcinoma. J Gastroenterol. 2005;40(3):225-235. 4. National Cancer Institute. Dictionary of cancer terms. National Cancer Institute Web site. http://www.cancer.gov/dictionary/. Accessed July 31, 2009.