Sunitinib and Chemoembolization in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

DISEASE CHARACTERISTICS:

* Histologically, cytologically, or serologically\* confirmed hepatocellular carcinoma meeting the following criteria:

  * 1-4 lesions
  * Involvement of 1 or both liver lobes NOTE: \*Alpha-fetoprotein (AFP) \> 500 mcg/L in high-risk patients
* Measurable disease by CT scan or MRI

  * Disease does not exceed 50% of the liver parenchyma
  * At least 1 lesion ≥ 3 cm in longest diameter
* Tumor burden involves \< 50% of the liver
* Refused surgery OR unresectable disease due to any of the following:

  * Multifocality
  * Advanced cirrhosis
  * Comorbid illness
* Candidate for chemoembolization
* No fibrolamellar histology
* No ascites
* No known brain metastases

PATIENT CHARACTERISTICS:

* ECOG performance status 0-2
* Life expectancy ≥ 12 weeks
* WBC ≥ 3,000/mm³
* ANC ≥ 1,500/mm³
* Hemoglobin ≥ 8.5 g/dL (transfusion allowed)
* Platelet count ≥ 100,000/mm³
* Bilirubin ≤ 2 mg/dL
* AST ≤ 5 times upper limit of normal (ULN)
* INR \< 1.5
* Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 30 mL/min
* No bleeding diathesis or coagulopathy
* No active congestive heart failure
* No uncontrolled angina
* No myocardial infarction within the past 12 months
* No cardiac arrhythmia
* Ejection fraction ≥ 45% (in patients with known coronary artery disease and in patients \> 50 years of age)
* Child-Pugh class A or B cirrhosis
* No impedance of hepatopedal blood flow (portal vein thrombosis)
* No thrombosis of the main portal vein
* No encephalopathy
* No biliary obstruction
* No variceal bleed within the past 6 months
* No history of allergic reactions attributed to compounds of similar chemical or biologic composition to sunitinib malate
* No absolute contraindication to doxorubicin, iodinated contrast material, microfibrillar collage hemostat, or dexamethasone
* No other concurrent uncontrolled illness including, but not limited to, any of the following:

  * Ongoing or active infection
  * Psychiatric illness or social situation that would limit compliance with study requirements
* No other active malignancies within the past year except nonmelanoma skin cancer or carcinoma in situ
* No significant traumatic injury within the past 4 weeks
* No QTc prolongation (i.e., QTc interval ≥ 500 msec) or other significant ECG abnormalities
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception during and for 6 months after the completion of study treatment

PRIOR CONCURRENT THERAPY:

* Recovered from prior therapy
* Prior liver-directed therapy, such as chemoembolization, radiofrequency ablation, cryoablation, or ethanol injection allowed if the following criteria are met:

  * Treated lesion remains inactive by CT scan or MRI and new lesion being embolized is distinct from the previously treated lesion
  * Radiographic progression of previously treated lesion requiring re-embolization
* Prior liver resection allowed
* Prior immunotherapy allowed
* No prior antiangiogenesis therapy
* No prior liver transplantation

  * Patients awaiting a cadaveric or orthotopic liver transplantation are eligible provided they have end-stage liver disease with a priority score of \< 20 points
* More than 4 weeks since prior radiotherapy or chemotherapy (6 weeks for nitrosoureas or mitomycin C)
* More than 4 weeks since prior major surgery or open biopsy
* At least 1 week since prior fine needle biopsy
* No concurrent immunotherapy
* No concurrent radiotherapy
* No concurrent combination antiretroviral therapy for HIV-positive patients
* No concurrent therapeutic doses of coumarin-derivative anticoagulants (e.g., warfarin)

  * Doses of ≤ 1 mg/day are allowed for prophylaxis of thrombosis as long as INR ≤ 1.5
  * Both full dose and prophylactic dose low molecular weight heparin allowed as long as PT INR ≤ 1.5
* No anticipated major surgery during and for 3 months after completion of study treatment
* No other concurrent investigational agents
* No other concurrent anticancer therapy