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针对晚期肝细胞癌的免疫疗法多学科治疗方法。

A multidisciplinary approach with immunotherapies for advanced hepatocellular carcinoma.

作者信息

Lee Yu Rim

机构信息

Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

出版信息

J Liver Cancer. 2023 Sep;23(2):316-329. doi: 10.17998/jlc.2023.09.04. Epub 2023 Sep 22.

Abstract

Hepatocellular carcinoma (HCC) is a highly aggressive disease that is usually diagnosed at an advanced stage. Advanced HCC has limited treatment options and often has a poor prognosis. For the past decade, tyrosine kinase inhibitors have been the only treatments approved for advanced HCC that have shown overall survival (OS) benefits; however, but their clinical efficacy has been limited. Recent trials have demonstrated promising advancements in survival outcomes through immunotherapy-based treatments, such as combinations of immune checkpoint inhibitors (ICIs) with other ICIs, antiangiogenic drugs, and locoregional therapies. The atezolizumab-bevacizumab and durvalumab-tremelimumab (STRIDE) regimen has significantly improved survival rates as a first-line treatment and has become the new standard of care. Therefore, combined treatments for advanced HCC can result in better treatment outcomes owing to their synergistic effects, which requires a multidisciplinary approach. Ongoing studies are examining other therapeutic innovations that can improve disease control and OS rates. Despite improvements in the treatment of advanced HCC, further studies on the optimal treatment selection and sequences, biomarker identification, combination approaches with other therapies, and development of novel immunotherapy agents are required. This review presents the current treatment options and clinical data of the ICI-based combination immunotherapies for advanced HCC from a multidisciplinary perspective.

摘要

肝细胞癌(HCC)是一种侵袭性很强的疾病,通常在晚期才被诊断出来。晚期HCC的治疗选择有限,预后往往较差。在过去十年中,酪氨酸激酶抑制剂一直是唯一被批准用于晚期HCC且显示出总生存期(OS)获益的治疗方法;然而,其临床疗效有限。最近的试验表明,通过基于免疫疗法的治疗,如免疫检查点抑制剂(ICI)与其他ICI、抗血管生成药物和局部区域疗法的联合使用,在生存结局方面取得了有前景的进展。阿替利珠单抗-贝伐单抗和度伐利尤单抗-曲美木单抗(STRIDE)方案作为一线治疗显著提高了生存率,并已成为新的治疗标准。因此,晚期HCC的联合治疗因其协同作用可带来更好的治疗效果,这需要多学科方法。正在进行的研究正在考察其他可改善疾病控制和OS率的治疗创新。尽管晚期HCC的治疗有所改善,但仍需要进一步研究最佳治疗选择和顺序、生物标志物识别、与其他疗法的联合方法以及新型免疫治疗药物的开发。本综述从多学科角度介绍了基于ICI的晚期HCC联合免疫疗法的当前治疗选择和临床数据。

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