肝细胞癌的现行和新兴治疗策略

StephenW

Current and Emerging Treatment Strategies for Hepatocellular Carcinoma



Systemic Therapy

At the time of HCC diagnosis, 45% of patients have regional or distant disease. Patients with advanced disease are usually ineligible for curative locoregional treatments and often require systemic therapy instead. Systemic therapies for HCC are broadly classified as molecularly targeted therapy or immunotherapy with checkpoint inhibitors. HCC is often refractory to systemic chemotherapy, and chemotherapy should only be used in the context of a clinical trial.

Four systemic agents have been approved for HCC: Sorafenib, regorafenib and lenvatinib are targeted multikinase inhibitors, and nivolumab is an immuno-oncology therapeutic known as a programmed cell death protein 1 (PD-1) inhibitor. Sorafenib is the first-line standard of care for patients with metastatic or unresectable HCC and Child-Pugh A or B cirrhosis who are not candidates for transplantation or other potentially curative treatments. Regorafenib and nivolumab are approved as second-line therapies for HCC for patients previously treated with sorafenib.
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全身治疗

在HCC诊断时，45％的患者患有局部或远处疾病。患有晚期疾病的患者通常不具备治疗性局部区域治疗的资格，并且通常需要全身治疗。 HCC的全身治疗大致分为分子靶向治疗或具有检查点抑制剂的免疫治疗。 HCC通常对全身化疗难以治疗，化疗仅应在临床试验中使用。

已批准四种全身性药物用于HCC：索拉非尼，瑞格非尼和lenvatinib是靶向多激酶抑制剂，nivolumab是一种免疫肿瘤学治疗剂，称为程序性细胞死亡蛋白1（PD-1）抑制剂。索拉非尼是转移性或不可切除的HCC和Child-Pugh A或B肝硬化患者的一线护理标准，这些患者不适合移植或其他潜在的治愈性治疗。 Regorafenib和nivolumab被批准用于之前接受索拉非尼治疗的患者的HCC二线治疗。
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