PDF(Pubmed)
Abstract：
Patients with advanced hepatocellular carcinoma (HCC) have several systemic treatment options. There are many known risk factors for HCC, and although some, such as hepatitis C, are now treatable, others are not. For example, metabolic dysfunction-related chronic liver disease is increasing in incidence and has no specific treatment. Underlying liver disease, drug resistance, and an increasing number of treatment options without specific biomarkers are all challenges in selecting the best treatment for each patient. Conventional chemotherapy is almost never used for advanced-stage disease, which instead is treated with immunotherapy, tyrosine kinase inhibitors, and VEGF inhibitors. Immune checkpoint inhibitors targeting various receptors have been or are currently undergoing clinical evaluation. Ongoing trials with three-drug regimens may be the future of advanced-stage HCC treatment. Other immune-modulatory approaches of chimeric antigen receptor-modified T cells, bispecific antibodies, cytokine-induced killer cells, natural killer cells, and vaccines are in early-stage clinical trials. Targeted therapies remain limited for HCC but represent an area of potential growth. As we shift away from first-line sorafenib for advanced HCC, clinical trial control arms should comprise a standard treatment other than sorafenib, one that is a better comparator for advancing therapies.
摘要：
晚期肝细胞癌（HCC）患者有几种全身治疗选择。肝癌有许多已知的危险因素，虽然有些,比如丙型肝炎，现在可以治疗，其他人不是。例如,与代谢功能障碍相关的慢性肝病的发病率正在增加，并且没有特异性的治疗方法。潜在的肝脏疾病，耐药性,越来越多的无特异性生物标志物的治疗方案都是为每位患者选择最佳治疗方案的挑战.常规化疗几乎从未用于晚期疾病，而是用免疫疗法治疗，酪氨酸激酶抑制剂，和VEGF抑制剂。靶向各种受体的免疫检查点抑制剂已经或目前正在进行临床评估。正在进行的三药方案试验可能是晚期HCC治疗的未来。嵌合抗原受体修饰的T细胞的其他免疫调节方法，双特异性抗体，细胞因子诱导的杀伤细胞，自然杀伤细胞,疫苗正处于早期临床试验阶段。针对HCC的靶向治疗仍然有限，但代表了潜在的增长领域。随着我们从一线索拉非尼转向晚期肝癌，临床试验对照组应包括索拉非尼以外的标准治疗，这是一个更好的比较促进治疗。
