|
- 现金
- 62111 元
- 精华
- 26
- 帖子
- 30437
- 注册时间
- 2009-10-5
- 最后登录
- 2022-12-28
|
4. Expert commentary
HCC is a leading cause of cancer-related death, with an estimated 750,000 new cases of HCC worldwide every year. It is
further estimated that up to 80% of these cases are as a result
of HBV or HCV infection, with evidence showing that HCC
mortality and incidence is correlated with prevalence of HBV.
Surgical resection, lT, chemotherapy, and local tumor ablation
are currently the main treatment options available, however in
cases related to HBV infection there should also be an antiviral
component of treatment to prevent recurrence. Considering
the continued high rates of Hepatitis B in sub-Saharan Africa
and East Asia, there remains a high need for clear and effective
antiviral treatment pathways in these regions for HBV patients
that subsequently develop HCC. This need exists in three
distinct but related patient populations, namely:
(1) HBV-related HCC patients who have undergone lT. In
these patients, a combination of HBIg and NAs with a
high genetic barrier to resistance (i.e. ETV or TDF) prove
to effectively prevent HBV recurrence posttransplant. It
is still unclear whether HBIg discontinuation after prior
combination therapy or NA monotherapy could provide
equivalent long-term benefits, and this should be investigated in the future from both an efficacy and cost-effectiveness perspective.
(2) HBV-related HCC patients with curative treatment.
Accumulating evidence shows that NA antiviral treatment could reduce HCC recurrence and improve overall
survival rate. This supports the use of NA antiviral therapy in the tertiary prevention of HCC.
(3) HBV-related HCC patients without curative treatment.
NAs have been shown to be effective in preventing HBV
reactivation in patients receiving chemotherapy.
However, future considerations should evaluate
whether NAs should be administered in all or only a
subset of late-stage HCC patients. This question should
be considered from both a disease status perspective
and an expected lifespan status.
An important next step would therefore be to conduct a series of
clinical trials. Of particular interest would be the initiation of large
multicenter trials with longer treatment duration from across
Asia. This would enable specific sub-analyses and meta-analyses
of the data to confirm the safety and efficacy of existing treatments in these high-risk populations, and would be of benefit in
the generation of robust local guidelines. By understanding this
issue more thoroughly, it will not only be possible to assess the
best treatment option for each patient but will also provide data
on the total healthcare cost associated with the long-term outcomes of the patients. This in turn will allow for more thorough
total cost assessments, and potentially lead to an improved
economic strategy for treatment of HBV-related HCC.
Although treatments are available for HBV-related HCC,
future focus should also be on the prevention of HBV, thus
avoiding HBV-related HCC. Safe and effective vaccines for HBV
are available which have enabled infection rates to drop to
less than 1% in Western Europe and North America. With
improved prevention and clearer guidance for treatment of
HBV-related HCC, we hope that the healthcare burden of this
disease can be reduced across the region.
专家评论
HCC是癌症相关死亡的主要原因，每年在全球范围内估计有75万例HCC。它是
进一步估计，这些案件中高达80％是结果
的HBV或HCV感染，有证据表明HCC
死亡率和发病率与HBV流行率相关。
手术切除，lT，化疗和局部肿瘤消融
目前是可用的主要治疗方案，但是
与HBV感染相关的病例也应该是抗病毒药物
组成部分治疗以预防复发。考虑到
撒哈拉以南非洲地区乙型肝炎持续高发
而东亚地区仍然需要清晰有效
这些区域的HBV病人的抗病毒治疗途径
随后发展HCC。这个需求存在于三个
不同但相关的患者群体，即：
（1）经历了lT的HBV相关HCC患者。在
这些患者，HBIg和NAs的组合与a
高抗遗传屏障（即ETV或TDF）证明
有效预防移植后HBV复发。它
HBIg以前是否停药仍不清楚
联合治疗或NA单药治疗可提供
等效的长期利益，今后应从效能和成本效益的角度进行调查。
（2）治疗性HBV相关性肝癌患者。
积累的证据表明，NA抗病毒治疗可以减少HCC复发并改善整体
存活率。这支持在三联预防肝癌中使用NA抗病毒治疗。
（3）HBV相关HCC患者无治疗。
NAs已被证明能有效预防HBV
接受化疗的患者重新激活。
然而，未来的考虑应该是评估的
是否应该全部或只管理一个
晚期HCC患者的子集。这个问题应该
从疾病状态角度考虑
和预期的使用寿命状态。
因此，重要的下一步是进行一系列的工作
临床试验。特别感兴趣的是启动大型
多中心试验，治疗持续时间较长
亚洲。这将有助于进行具体的次级分析和荟萃分析
的数据，以确认现有治疗在这些高危人群中的安全性和有效性，并将受益
生成强大的本地指南。通过了解这一点
问题更彻底，不仅可以评估
每个病人的最佳治疗方案，但也将提供数据
关于与患者长期结局相关的总医疗费用。这反过来又会让更彻底的
总成本评估，并可能导致改进
治疗HBV相关HCC的经济策略。
虽然治疗可用于HBV相关HCC，
未来重点还应该是预防HBV，因此
避免与HBV相关的HCC。安全有效的HBV疫苗
可以使感染率下降到
不到1％在西欧和北美。同
改善预防和更明确的治疗指导
HBV相关HCC，我们希望这个的医疗负担
整个地区的疾病可以减少。 |
|
发表于 2017-6-30 21:56