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Abstract：
Hepatocellular carcinoma (HCC) incidence and mortality have shown an unfavorable upward trend over the last two decades, especially in developed countries. More than one-sixth of the patients have advanced HCC at presentation. Systemic therapy remains the treatment of choice for these patients. Current options include tyrosine kinase inhibitors (TKIs) and immunotherapy. This review aims to summarize current knowledge on the rapidly evolving field of systemic therapy with several newly approved medications over the last year. Sorafenib remains one of the first-line treatment choices for patients with hepatitis C etiology, intermediate to advanced HCC stage, and Child-Pugh class A. Lenvatinib is the other first-line drug that might have better efficacy in non-hepatitis C etiologies and advanced HCC without portal vein thrombosis. Patients intolerant to first-line therapy might benefit from immunotherapy with nivolumab or pembrolizumab. In those who fail first-line therapy, the choice should be based on the side effects related to previous treatment, performance status, and underlying liver dysfunction. Ongoing studies are investigating immunotherapy alone or immunotherapy in combination with TKIs as first-line therapy. Several second-line options for combination systemic therapy and systemic plus local-regional treatment are under investigation. Future studies should focus on identifying reliable biomarkers to predict response to therapy and to better stratify patients at high risk for progression. Multidisciplinary approach is pivotal for successful outcomes in patients with advanced HCC.
摘要：
肝细胞癌（HCC）的发病率和死亡率已显示出不利的上升趋势在过去的二十年，特别是在发达国家。超过六分之一的患者在就诊时患有晚期HCC。全身治疗仍然是这些患者的首选治疗方法。目前的选择包括酪氨酸激酶抑制剂(TKIs)和免疫疗法。这篇综述旨在总结过去一年中使用几种新批准的药物进行系统治疗的快速发展领域的最新知识。索拉非尼仍然是丙型肝炎患者病因的一线治疗选择之一，中晚期肝癌阶段，和Child-Pugh类A.Lenvatinib是另一种一线药物，可能在非丙型肝炎病因和无门静脉血栓形成的晚期HCC中具有更好的疗效。对一线治疗不耐受的患者可能受益于nivolumab或pembrolizumab的免疫治疗。在那些一线治疗失败的人中，选择应基于与先前治疗相关的副作用，性能状态，和潜在的肝功能障碍。正在进行的研究正在研究单独的免疫疗法或与TKI联合的免疫疗法作为一线疗法。正在研究联合全身治疗和全身加局部区域治疗的几种二线选择。未来的研究应该集中在确定可靠的生物标志物，以预测对治疗的反应，并更好地对进展风险高的患者进行分层。多学科方法对于晚期HCC患者的成功预后至关重要。
