佐剂和组合疗法肝癌

StephenW

Adjuvant and Combination Therapies for HCC
Panelists: Ghassan K. Abou-Alfa,MD Memorial Sloan-Kettering Cancer; Richard Finn, MD, UCLA; Jeff Geschwind, MD, Johns Hopkins ; Robert G Gish, MD, University of California, San Diego;
and Adam C. Yopp, MD, University of Texas Southwestern Medical Center
Published Online: Monday, August 3, 2015


The concept of using sorafenib in the adjuvant setting is a bit flawed, since it is being used as more of a chemopreventive approach for patients with hepatocellular carcinoma (HCC), according to Adam C. Yopp, MD. In terms of trials of adjuvant sorafenib, a phase III study that randomized patients after surgical resection or radiofrequency ablation to sorafenib or placebo did not show any improvement in recurrence-free survival. Currently, in the adjuvant setting, there is nothing to offer to patients with HCC, Yopp concludes.

As a hepatologist, Robert G. Gish, MD, FAASLD, stresses the need to treat the underlying disease. If a patient has both liver disease and hepatitis B, it has been shown that suppressing the hepatitis B will delay the time to recurrence and reduce the overall risk of recurrence of the liver disease. Similarly, curing underlying hepatitis C will result in a healthier liver, as well as delay recurrence and decreased the risk of recurrence. More data are needed to understand the risk reduction potential of treating nonalcoholic steatohepatitis (NASH), he adds.

The concept of combining chemoembolization with an antiangiogenic agent is based on the fact that angiogenesis is actually a biomarker for a poor prognosis in HCC. If a patient has higher VEGF levels they are more likely to do poorly, regardless of any subsequent therapy, states Jeff Geschwind, MD. Additionally, within 24 to 36 hours following chemoembolization, there is a significant rise in VEGF levels in the blood, suggesting there could be synergy with an antiangiogenic agent, such as sorafenib.

This theory has been tested in several studies, including the ECOG 1208 and SPACE trials. The combination may be effective in patients with liver-dominant disease with some extrahepatic disease or macrovascular invasion. Many trials throughout the world have established a safety profile of the combination, states Geschwind. It doesn’t matter whether it is administered continuously, sequentially, or interrupted, he says; the bottom line is that these treatments are safe to use in combination.
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StephenW

佐剂和组合疗法肝癌
演讲嘉宾：加桑K.阿布 - 阿尔法，MD纪念斯隆 - 凯特琳癌症;理查德·芬恩，医学博士，加州大学洛杉矶分校;杰夫Geschwind，医学博士，美国约翰霍普金斯大学;罗伯特摹吉什，医学博士，美国加州大学圣地亚哥分校;
和亚当C. Yopp，医学博士，德克萨斯大学西南医学中心
发布时间：星期一，2015年8月3日


在辅助治疗中使用索拉非尼的概念是有点瑕疵，因为它被用作多的患者肝细胞癌（HCC）化学预防的方针，按照亚当C. Yopp，MD。在辅助索拉非尼的临床试验方面，III期研究，手术切除或射频消融索拉非尼或安慰剂后患者随机分组并没有显示在无复发生存率任何改善。目前，在辅助治疗，有什么可提供给患者的肝癌，Yopp总结。

作为一个肝病，罗伯特·吉什，MD，FAASLD，强调需要治疗潜在疾病。如果病人有既肝病和乙型肝炎，它已经表明，抑制乙肝将延迟复发和减少复发的肝脏疾病的整体风险的时间。类似地，固化底层丙肝将导致更健康的肝脏，以及延迟复发和降低复发的风险。需要更多的数据来了解治疗非酒精性脂肪性肝炎（NASH）的风险降低潜力，他补充道。

与抗血管生成剂联合化疗栓塞的概念是基于这样的事实，血管生成实际上是一个生物标志物预后不良肝癌。如果病人有更高的VEGF水平，他们更可能做不好，不论任何后续治疗，状态杰夫Geschwind医师。此外，以下化学栓塞24至36小时内，有一个显著上升VEGF水平在血液中，这表明有可能是与抗血管生成剂的协同作用，如索拉非尼。

这种理论在一些研究，包括ECOG 1208和空间试验所验证。该组合可以是有效的肝病患者显性疾病与某些肝外疾病或大血管侵袭。世界各地的许多试验已经建立的组合的安全性，指出Geschwind。不要紧无论是连续给药，顺序地，或中断，他说;底线是，这些治疗是安全的组合使用。
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