晚期肝细胞癌的一线治疗：更新

StephenW

晚期肝细胞癌的一线治疗：更新
Mehmet Akce 1 , Bassel F El-Rayes 2 , Tanios S Bekaii-Saab 3
隶属关系
隶属关系

    1
    美国乔治亚州亚特兰大埃默里大学医学院 Winship 癌症研究所血液学和内科肿瘤学系。
    2
    美国阿拉巴马大学伯明翰分校奥尼尔综合癌症中心内科血液和肿瘤科，美国阿拉巴马州伯明翰。
    3
    梅奥诊所内科肿瘤内科，5777 E Mayo Blvd, Phoenix, AZ 85254, USA。

    PMID：35432597 PMCID：PMC9006370 DOI：10.1177/17562848221086126

抽象的

肝细胞癌 (HCC) 是美国癌症相关死亡率增长最快的原因，预计到 2030 年将成为美国癌症相关死亡率的第三大原因。主要风险因素包括酒精性肝硬化、慢性乙型肝炎、丙型肝炎和非酒精性脂肪性肝炎 (NASH)。超过一半的患者在就诊时患有晚期疾病。目前批准的一线全身治疗方案包括索拉非尼、乐伐替尼和阿特珠单抗/贝伐单抗。在过去十年中，阿特珠单抗/贝伐单抗一线治疗的中位总生存期为 19.2 个月，生存率显着提高。基于随机 III 期 HIMALAYA 试验的积极结果，durvalumab 和 tremelimumab 联合可能成为另一个一线选择。免疫检查点抑制剂 (ICI) 或 ICI 与其他新型药物联合的多项一线临床试验正在进行中。在一线环境中，识别基于 ICI 或基于酪氨酸激酶 (TKI) 的治疗的预测性生物标志物是一个未满足的需求。由于在一线索拉非尼之后研究了所有可用的二线及以上治疗，因此对先前接受过基于 ICI 治疗的患者的后续治疗定义不明确。在某些 HCC 亚组（例如 Child-Pugh B 和移植后复发性 HCC）中，一线全身治疗的定义不明确。 HCC 一线治疗的前景正在迅速变化，本文回顾了晚期 HCC 一线治疗的最新治疗方法。

关键词： 肝细胞癌；一线治疗；免疫疗法。

©作者，2022。

StephenW

Frontline therapy for advanced hepatocellular carcinoma: an update
Mehmet Akce  1 , Bassel F El-Rayes  2 , Tanios S Bekaii-Saab  3
Affiliations
Affiliations

    1
    Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
    2
    Division of Hematology and Oncology, Department of Internal Medicine, O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL, USA.
    3
    Division of Medical Oncology, Department of Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85254, USA.

    PMID: 35432597 PMCID: PMC9006370 DOI: 10.1177/17562848221086126

Abstract

Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer-related mortality in the United States and is projected to be the third leading cause of cancer-related mortality in the United States by 2030. Main risk factors include alcoholic cirrhosis, chronic hepatitis B, hepatitis C, and nonalcoholic steatohepatitis (NASH). More than half of the patients have advanced-stage disease at presentation. Currently approved frontline systemic therapy options include sorafenib, lenvatinib, and atezolizumab/bevacizumab. Over the past decade, there has been a significant improvement in survival with a median overall survival of 19.2 months reported with first-line treatment with atezolizumab/bevacizumab. Based on positive results of randomized phase III HIMALAYA trial, durvalumab and tremelimumab combination could become another frontline option. Multiple frontline clinical trials with immune checkpoint inhibitor (ICI) or ICI combined with other novel agents are underway. In the frontline setting, identifying predictive biomarkers for ICI-based or tyrosine kinase (TKI)-based therapy is an unmet need. Subsequent treatment is poorly defined in patients with prior ICI-based therapy since all the available second-line and beyond therapy was studied after first-line sorafenib. Frontline systemic therapy is poorly defined in certain subgroups of HCC such as Child-Pugh B and post-transplant recurrent HCC. The landscape of frontline HCC treatment is rapidly changing, and this article reviews the most recent treatment approaches to frontline therapy for advanced HCC.

Keywords: Hepatocellular carcinoma; frontline treatment; immunotherapy.

© The Author(s), 2022.

StephenW

https://journals.sagepub.com/doi/pdf/10.1177/17562848221086126