Drugs for HBV treatment fall mainly into two categories: immune modulators (interferons) and those that inhibit HBV replication. Responses to therapy are described as “initial response”, measured at 6 months or 12 months into treatment, “maintained response” when the response is still present at the patients last visit, and a “sustained response” when the response is still present 6 months after the completion of therapy. A resolved infection or "response" is a sustained loss of HBsAg.

Immune Modulators
interferon alpha-2b (peg-Intron A)
pegylated interferon (Pegasys, Roche)

Inhibitors of HBV replication
lamivudine (Epivir-HBV, GlaxoSmithKline)
entecavir (Baraclude,Bristol-Myers Squibb)
adefovir dipivoxil (Hepsera, Gilead Sciences)
telbivudine (Tyzeka, Novartis)
tenofovir, (Viread, Gilead Sciences)

Lamivudine has been first-line treatment for chronic hepatitis B. The drug inhibits the reverse transcriptase action of the DNA polymerase. Advantages over interferons include a more rapid response, oral administration, and a good tolerability with fewer adverse effects. The disadvantages of this drug include uncertainty about the durability of HBeAg seroconversion and a high rate of antiviral resistance. The 3-year relapse rate has varied between 38% and 77%.
Adefovir is the second nucleoside drug approved for the treatment of chronic HBV. It has action similar to that of lamivudine in that it inhibits the DNA reverse transcriptase action. It was approved for use in 2002. It may be less effective than lamivudine but has a low rate of antiviral resistance. The drug is administered by mouth for 48 weeks. Other drugs include entecavir, telbivudine and tenofoivir which are all available in oral preparations. Of these, tenofovir may be the most potent and the most suitable for patients with lamivudine resistance and those who have had a poor response to the other nucleoside agents.

Although drug treatment has yielded disappointing results, the National Institutes of Health recommends that all patients with chronic HCV be considered for drug treatment. Factors that affect outcome are underlying liver damage, patient motivation, and HCV genotype. Treatment of HCV genotypes 1 or 4 have a success rate of about 40% to 55%, but patients with HCV genotypes 2 or 3 have a 70% to 80% treatment success rate, commonly referred to as a sustained viral response (SVR), meaning virus is no longer detectable in the blood. Below is the recommended treatment guideline according to American Association for the Study of Liver Disease.

Options to treat liver cancers:

Due to the low survival of liver cancer, patients should consider participation in a clinical trial to find better treatments.

FDA approved agents
Nexavar (Sorafenib) is a drug that stops the growth of small blood vessels that feed cancers and allow them to grow. Sorafenib is FDA approved for the treatment of patients with unresectable hepatocellular carcinoma (HCC).

Patients with a healthy liver.
1) Surgery: If your liver is healthy
a. Laparoscopic: less painful, shorter hospitalization
b. Open: if laparoscopic surgery not possible

Patients with an unhealthy liver (cirrhosis).

1) Liver transplant: in patients with small cancers liver transplant is a treatment option. Eligible patients either have a single tumor , less than 5 cm in diameter or no more than 3 tumors, each being no greater than 3 cm in diameter. There can be no tumor outside the liver or invasion of tumor into visible vessels in the the liver.

2) Local destruction of cancer within your liver: If your liver is not healthy enough to tolerate surgery, options to treat the cancer include

a. Hepatic artery embolization: injection of tiny particles to block blood supply to cancer, causing it to die. Often combined with injecting chemotherapy into blood supply feeding cancer.

b. Radio Frequency Ablation: uses a multi-prong needle to cook cancer within your liver. Can be performed using laparoscopic surgery or through the skin (percutaneous).

c. Alcohol injection: for cancers less than 2 cm in diameter injection of 5-10 ml of alcohol can be used to destroy the cancer.

d. 3D conformal radiation: If the cancer invades the veins feeding your liver (portal vein), highly focused radiation is used to stop the growth of the tumor in the vein.

e. Yitrium-90 particle: These are insoluble glass microspheres where Yttrium-90 is an integral constituent of the glass. Yttrium-90 emits pure beta radiation that can kill a cancer.

Pancreas cancer remains a deadly disease. Over 9 out of 10 people with pancreas cancer will not liver longer than 5 years from the time they were first diagnosed.

At the National Cancer Institute patient treatment information web site, clinical trial is listed as a treatment option for patients with pancreas cancer.

Any patient with pancreas cancer should strongly consider enrolling in a clinical trial.