一线治疗后晚期不可切除肝细胞癌的全身治疗：来自香港、

StephenW

一线治疗后晚期不可切除肝细胞癌的全身治疗：来自香港、新加坡和台湾的专家建议
Thomas Yau 1 , David Tai 2 , Stephen Lam Chan 3 , Yi-Hsiang Huang 4 5 , Su Pin Choo 6 , Chiun Hsu 7 , Tan To Cheung 8 , Shi-Ming Lin 9 , Wei Peng Yong 10 , Joycelyn Lee 2 , Thomas Leung 11 , Tracy Shum 12 , Cynthia S Y Yeung 13 , Anna Yin-Ping Tai 14 , Ada Lai Yau Law 15 , Ann-Lii Cheng 16 17 , Li-Tzong Chen 18 19
隶属关系
隶属关系

    1
    香港大学医学系，中国香港。
    2
    新加坡国家癌症中心肿瘤内科，新加坡，新加坡。
    3
    香港中文大学临床肿瘤学系，中国香港。
    4
    台湾台北荣民总医院肠胃肝病科。
    5
    国立阳明交通大学医学院临床医学研究所，台北，台湾。
    6
    居里肿瘤学，新加坡，新加坡。
    7
    台湾大学癌症中心肿瘤内科，台北，台湾。
    8
    香港大学外科学系，中国香港。
    9
    台湾林国长庚纪念医院肠胃肝病科。
    10
    新加坡国立大学血液肿瘤学系，新加坡，新加坡。
    11
    香港养和医院肿瘤内科。
    12
    中国香港玛嘉烈医院肿瘤科。
    13
    中国香港协和医院。
    14
    中国香港伊利沙伯医院临床肿瘤科。
    15
    凯龙医疗，中国香港。
    16
    台湾大学医院内科和肿瘤科，台北，台湾。
    17
    台湾大学医学院肿瘤学研究所，台北，台湾。
    18
    国立癌症研究所，国立卫生研究院，台南，台湾。
    19
    台湾高雄医科大学高雄医科大学附属医院内科。

    PMID：36158587 PMCID：PMC9485972 DOI：10.1159/000525582

抽象的

背景：由于慢性乙型肝炎感染率高，亚洲的肝细胞癌 (HCC) 负担较重，占全球 HCC 病例的 70%。在过去的 20 年中，晚期 HCC 的全身治疗格局发生了重大变化——从酪氨酸激酶抑制剂到免疫肿瘤药物加抗血管内皮生长因子药物。鉴于系统性治疗选择的增加，适当的治疗顺序对于优化患者预后变得至关重要。本文评估证据并为晚期 HCC 患者一线治疗后使用全身治疗提供专家建议。

摘要：基于 2021 年初举行的三场虚拟会议，由来自香港、新加坡和台湾的肿瘤学家、肝病学家和肝胆外科医生组成的 17 名专家团队审查了一线后 HCC 系统治疗的现有数据，并制定了 28 项声明.这些声明旨在为选择一线和后续治疗提供专家指导，并在特殊情况下推荐治疗，例如肝功能差、移植后、近期胃肠道出血或自身免疫性疾病。支持这些陈述的数据来自临床试验和真实世界的研究。然后使用 5 点李克特量表匿名评估 28 条陈述，其中 24 条达成共识，预定义为达到 75% 的一致。生成的声明涵盖一线全身治疗的选择、二线全身治疗的考虑和目标、一线治疗后的治疗选择以及一线酪氨酸激酶抑制剂、免疫肿瘤单药治疗或免疫肿瘤学后的治疗建议联合治疗。作者还就肝功能不全、肝移植和近期胃肠道或自身免疫性疾病患者使用二线全身治疗分享了专家意见。

关键信息：这些专家声明总结了在不可切除的晚期或转移性 HCC 患者一线治疗后选择全身治疗的最新数据和专家意见。

关键词： 肝细胞癌；肝癌;全身治疗。

版权所有 © 2022 作者。巴塞尔 S. Karger AG 出版。
利益冲突声明

陈博士曾收到阿斯利康、默克夏普、卫材和易普森的咨询费，以及拜耳、卫材、易普森、Sirtex 和默克夏普的研究经费。陈博士也是肝癌的编辑委员会成员。陈博士先后获得葛兰素史克、默克雪兰诺、欧比制药、辉瑞、北极星、科技部、卫生福利部的资助；来自 Bristol Myers Squibb、Eli Lilly、Five Prime、Merck Sharp & Dohme、Merrimack Pharmaceuticals、Ono Pharmaceutical、PharmaEngine 和 Shire 的个人费用；来自 Celgene 的赠款和非财务支持；诺华、Syncore 和 TTY Biopharm 的赠款、个人费用和非财务支持。程博士获得了拜耳药业、卫材、罗氏/基因泰克、中外药业和 IQVIA 的差旅支持； Bayer Yakuhin, Ltd.、Novartis、Eisai、Ono Pharmaceutical 和 Amgen Taiwan 的演讲局酬金；以及来自阿斯利康、百时美施贵宝、卫材、默克雪兰诺、诺华、小野制药、Exelixis、IPSEN Innovation、拜耳医疗保健、默克夏普、罗氏/基因泰克、百济神州、F. Hoffmann-La Roche 和 IQVIA 的咨询费。郑博士是肝癌的副主编。 Choo博士拥有百时美施贵宝的股票，并获得了百时美施贵宝、拜耳、罗氏、阿斯利康、默沙东和易普森的酬金和咨询费；她还收到了卫材的酬金。许博士曾获得阿斯利康、拜耳、百时美施贵宝/小野制药、卫材、易普森、默沙东和罗氏的酬金；以及来自 Bristol Myers Squibb/Ono Pharmaceuticals、Roche 和 Ipsen 的赠款或资金。黄教授曾担任顾问委员会或委员会成员，并获得艾伯维、吉利德科学、百时美施贵宝、小野制药、卫材、礼来、易普森、默克夏普和罗氏公司的酬金；并从 Gilead Sciences 和 Bristol Myers Squibb 获得赠款或资金。李博士收到了百时美施贵宝、易普森和拜耳的酬金；以及来自拜耳的赠款或资金。 DWM Tai 博士曾担任顾问委员会或委员会成员，曾获得诺华、Sirtex、默克夏普和多姆、新基、卫材和百时美施贵宝的酬金和咨询费；他还获得了诺华、百时美施贵宝和 Sirtex 的赠款或资金。邱博士曾担任顾问委员会或委员会成员，并获得过百时美施贵宝、默克夏普和多姆、Exelixis、易普生、卫材、阿斯利康、拜耳、诺华、EMD Sereon、艾伯维、辉瑞、礼来、Sirtex、Sillajen、 Taiho、OrigiMed、New B Innovation、Sirtex 和 H3 Biomedicine。 Yong 博士收到了 Amgen、Genentech、Bayer、Merck Sharpe & Dohme、Bristol Myers Squibb、Ipsen、Novartis、AstraZeneca、Eli Lilly 和 Taiho 的酬金。 Drs Cheung, Law, Leung, Lin, Shum, A.Y.P. Tai 和 Yeung 没有需要声明的潜在利益冲突。

StephenW

Systemic Treatment of Advanced Unresectable Hepatocellular Carcinoma after First-Line Therapy: Expert Recommendations from Hong Kong, Singapore, and Taiwan
Thomas Yau  1 , David Tai  2 , Stephen Lam Chan  3 , Yi-Hsiang Huang  4   5 , Su Pin Choo  6 , Chiun Hsu  7 , Tan To Cheung  8 , Shi-Ming Lin  9 , Wei Peng Yong  10 , Joycelyn Lee  2 , Thomas Leung  11 , Tracy Shum  12 , Cynthia S Y Yeung  13 , Anna Yin-Ping Tai  14 , Ada Lai Yau Law  15 , Ann-Lii Cheng  16   17 , Li-Tzong Chen  18   19
Affiliations
Affiliations

    1
    Department of Medicine, The University of Hong Kong, Hong Kong, China.
    2
    Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
    3
    Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
    4
    Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.
    5
    Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
    6
    Curie Oncology, Singapore, Singapore.
    7
    Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
    8
    Department of Surgery, The University of Hong Kong, Hong Kong, China.
    9
    Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkuo, Taiwan.
    10
    Department of Haematology-Oncology, National University of Singapore, Singapore, Singapore.
    11
    Department of Medical Oncology, Hong Kong Sanatorium & Hospital, Hong Kong, China.
    12
    Department of Oncology, Princess Margaret Hospital, Hong Kong, China.
    13
    Union Hospital, Hong Kong, China.
    14
    Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China.
    15
    Chiron Medical, Hong Kong, China.
    16
    Department of Internal Medicine and Oncology, National Taiwan University Hospital, Taipei, Taiwan.
    17
    Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.
    18
    National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.
    19
    Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

    PMID: 36158587 PMCID: PMC9485972 DOI: 10.1159/000525582

Abstract

Background: Asia has a high burden of hepatocellular carcinoma (HCC) due to the high rates of chronic hepatitis B infection and accounts for 70% of HCC cases globally. In the past 20 years, the systemic treatment landscape of advanced HCC has evolved substantially - from tyrosine kinase inhibitors to immune-oncology agents plus anti-vascular endothelial growth factor agents. The appropriate sequence of therapies has become critical in optimizing patient outcomes given the increase in systemic therapeutic options. This article evaluates the evidence and provides expert recommendations for the use of systemic therapies after first-line treatment in patients with advanced HCC.

Summary: Based on three virtual meetings held in early 2021, a team of 17 experts comprising oncologists, a hepatologist, and a hepatobiliary surgeon from Hong Kong, Singapore, and Taiwan reviewed available data about systemic treatments for HCC after first line and formulated 28 statements. These statements aimed to provide expert guidance on selecting first and subsequent lines of therapies as well as recommending therapies in special circumstances, such as poor liver function, posttransplantation, recent gastrointestinal bleeding, or autoimmune diseases. Data supporting the statements were drawn from clinical trials and real-world studies. The 28 statements were then evaluated anonymously using a 5-point Likert scale, and 24 reached consensus, predefined as achieving 75% agreement. Statements generated covered the selection of first-line systemic therapy, considerations and goals of second-line systemic therapies, treatment selection following first-line therapy, and treatment recommendations following first-line tyrosine kinase inhibitors, immune-oncology monotherapy, or immune-oncology combination therapy. The authors also shared expert opinion on the use of second-line systemic therapy in patients with liver dysfunction, liver transplantation, and recent gastrointestinal or autoimmune disease.

Key messages: These expert statements summarize the latest data and expert opinion on selecting systemic treatment following first-line therapy in patients with unresectable advanced or metastatic HCC.

Keywords: Hepatocellular carcinoma; Liver cancer; Systemic treatment.

Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.
Conflict of interest statement

Dr. Chan has received consulting fees from AstraZeneca, Merck Sharp & Dohme, Eisai, and Ipsen and research funding from Bayer, Eisai, Ipsen, Sirtex, and Merck Sharp & Dohme. Dr. Chan is also an Editorial Board Member of Liver Cancer. Dr. Chen has received grants from GlaxoSmithKline, Merck Serono, OBI Pharma, Pfizer, Polaris, Ministry of Science and Technology, and the Ministry of Health and Welfare; personal fees from Bristol Myers Squibb, Eli Lilly, Five Prime, Merck Sharp & Dohme, Merrimack Pharmaceuticals, Ono Pharmaceutical, PharmaEngine, and Shire; grants and nonfinancial support from Celgene; and grants, personal fees, and nonfinancial support from Novartis, Syncore, and TTY Biopharm. Dr. Cheng has received travel support from Bayer Yakuhin, Ltd., Eisai, Roche/Genentech, Chugai Pharmaceutical, and IQVIA; honoraria for speakers bureau from Bayer Yakuhin, Ltd., Novartis, Eisai, Ono Pharmaceutical, and Amgen Taiwan; and consulting fee from AstraZeneca, Bristol Myers Squibb, Eisai, Merck Serono, Novartis, Ono Pharmaceutical, Exelixis, IPSEN Innovation, Bayer Healthcare, Merck Sharp & Dohme, Roche/Genentech, BeiGene, F. Hoffmann-La Roche, and IQVIA. Dr. Cheng is an Associate Editor of Liver Cancer. Dr. Choo owns stock/shares of Bristol Myers Squibb and has received honoraria and consulting fee from Bristol Myers Squibb, Bayer, Roche, AstraZeneca, Merck Sharp & Dohme, and Ipsen; she has also received honoraria from Eisai. Dr. Hsu has received honoraria from AstraZeneca, Bayer, Bristol Myers Squibb/Ono Pharmaceuticals, Eisai, Ipsen, Merck Sharpe & Dohme, and Roche; and grants or funds from Bristol Myers Squibb/Ono Pharmaceuticals, Roche, and Ipsen. Professor Huang has been an advisory council or committee member and received honoraria from AbbVie, Gilead Sciences, Bristol Myers Squibb, Ono Pharmaceuticals, Eisai, Eli Lilly, Ipsen, Merck Sharp & Dohme, and Roche; and received grants or funds from Gilead Sciences and Bristol Myers Squibb. Dr. Lee has received honoraria from Bristol Myers Squibb, Ipsen, and Bayer; and grants or funds from Bayer. Dr. DWM Tai has been an advisory council or committee member, received honoraria and consulting fees from Novartis, Sirtex, Merck Sharpe & Dohme, Celgene, Eisai, and Bristol Myers Squibb; he has also received grants or funds from Novartis, Bristol Myers Squibb, and Sirtex. Dr. Yau has been an advisory council or committee member and received honoraria from Bristol Myers Squibb, Merck Sharpe & Dohme, Exelixis, Ipsen, Eisai, AstraZeneca, Bayer, Novartis, EMD Sereon, AbbVie, Pfizer, Eli Lilly, Sirtex, Sillajen, Taiho, OrigiMed, New B Innovation, Sirtex, and H3 Biomedicine. Dr. Yong has received honoraria from Amgen, Genentech, Bayer, Merck Sharpe & Dohme, Bristol Myers Squibb, Ipsen, Novartis, AstraZeneca, Eli Lilly, and Taiho. Drs Cheung, Law, Leung, Lin, Shum, A.Y.P. Tai, and Yeung have no potential conflict of interest to declare.

StephenW

https://www.karger.com/Article/Pdf/525582