Abstract:
Hepatocellular carcinoma (HCC) is a deadly cancer with a rising incidence in the last 20 years. Most patients are diagnosed late when curative treatment is no longer feasible. With the background of chronic liver disease in most patients, the management of HCC becomes more complicated, in which well-preserved liver function is a prerequisite for locoregional or systemic therapies. In 2008, sorafenib became the first systemic agent proven to provide survival benefit for patients with advanced-stage HCC. For nearly a decade, no treatment has succeeded in providing better results than sorafenib. However, numerous advances in systemic therapies have emerged in the last 5 years to fulfill the unmet needs of effective therapeutic options. Several agents have been approved for clinical use after positive results in phase III clinical trials, including lenvatinib, regorafenib, cabozantinib, ramucirumab, and lastly immune checkpoint inhibitor atezolizumab in combination with bevacizumab, a monoclonal antibody targeting the vascular endothelial growth factor. With various options available, knowledge on the clinical evidence of each drug, their safety profile, as well as the patient characteristics and preferences become mandatory in clinical decision making. The objective of this consensus is to help clinicians, health-care workers, and policy makers in providing best clinical care for HCC patients.
摘要:
肝细胞癌(HCC)是一种致命的癌症,在过去20年中发病率不断上升。当治愈性治疗不再可行时,大多数患者被诊断为晚期。以慢性肝病为背景,HCC的管理变得更加复杂,其中良好的肝功能是局部或全身治疗的先决条件。2008年,索拉非尼成为第一个被证明为晚期HCC患者提供生存益处的全身性药物。近十年来,没有任何治疗方法能够提供比索拉非尼更好的结果。然而,在过去的5年中,系统疗法取得了许多进展,以满足有效治疗选择的未满足需求。在III期临床试验中获得积极结果后,几种药物已被批准用于临床。包括lenvatinib,Regorafenib,卡博替尼,雷莫珠单抗,最后是免疫检查点抑制剂阿替珠单抗联合贝伐单抗,针对血管内皮生长因子的单克隆抗体。有各种选项可用,了解每种药物的临床证据,他们的安全概况,以及患者特征和偏好在临床决策中成为强制性的。这种共识的目的是帮助临床医生,卫生保健工作者,和政策制定者为HCC患者提供最佳临床护理。