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Abstract：
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in India. This review explores the epidemiological trends and the landscape of systemic therapy for HCC in the Indian context, acknowledging the recent shift in etiology from viral hepatitis to lifestyle-associated factors. A comprehensive review of the literature was conducted, including data from the Global Cancer Observatory and the Indian Council of Medical Research, along with a critical analysis of various clinical trials. The article investigates systemic therapies in-depth, discussing their mechanisms, efficacy, and adaptation to Indian healthcare framework. Progression-free survival with a hazard ratio of ≤0.6 compared to sorafenib, overall survival of ∼16-19 months, and objective response rate of 20-30% are the defining thresholds for systemic therapy clinical trials. Systemic therapy for advanced HCC in India primarily involves the use of tyrosine kinase inhibitors such as sorafenib, lenvatinib, regorafenib, and cabozantinib, with sorafenib being the most commonly used drug for a long time. Monoclonal antibodies such as ramucirumab and bevacizumab and immune-checkpoint inhibitors, such as atezolizumab, nivolumab, and pembrolizumab, are expanding treatment horizons. Lenvatinib has emerged as a cost-effective alternative, and the combination of atezolizumab and bevacizumab has demonstrated superior outcomes in terms of overall survival and progression-free survival. Despite these advances, late-stage diagnosis and limited healthcare accessibility pose significant challenges, often relegating patients to palliative care. Addressing HCC in India demands an integrative approach that not only encompasses advancements in systemic therapy but also targets early detection and comprehensive care models. Future strategies should focus on enhancing awareness, screening for high-risk populations, and overcoming infrastructural disparities. Ensuring the judicious use of systemic therapies within the constraints of the Indian healthcare economy is crucial. Ultimately, a nuanced understanding of systemic therapeutic options and their optimal utilization will be pivotal in elevating the standard of HCC care in India.
摘要：
肝细胞癌（HCC）是印度癌症相关死亡率的主要原因。这篇综述探讨了在印度背景下HCC的流行病学趋势和系统治疗的前景。承认最近从病毒性肝炎到生活方式相关因素的病因转变。对文献进行了全面回顾，包括全球癌症观察站和印度医学研究理事会的数据，以及对各种临床试验的批判性分析。本文深入研究了全身疗法，讨论它们的机制，功效,并适应印度的医疗保健框架。与索拉非尼相比，风险比≤0.6的无进展生存率，16-19个月的总生存期，20-30%的客观缓解率是系统治疗临床试验的定义阈值.在印度，晚期肝癌的全身治疗主要涉及使用酪氨酸激酶抑制剂，如索拉非尼，lenvatinib,Regorafenib,和卡博替尼,索拉非尼是长期以来最常用的药物。单克隆抗体如雷莫西单抗和贝伐单抗和免疫检查点抑制剂，比如阿替珠单抗，Nivolumab,和派博利珠单抗，正在扩大治疗范围。Lenvatinib已经成为一种具有成本效益的替代品，阿替珠单抗和贝伐单抗的联合治疗在总生存期和无进展生存期方面表现出优异的结局.尽管取得了这些进展,晚期诊断和有限的医疗保健可及性会带来重大挑战，经常让病人接受姑息治疗。在印度解决HCC需要一种综合的方法，不仅包括系统治疗的进步，而且还针对早期检测和全面的护理模式。未来的战略应侧重于提高认识，高危人群筛查,克服基础设施差距。确保在印度医疗保健经济的约束下明智地使用系统疗法至关重要。最终,对全身治疗选择及其最佳利用的细微差别的理解将是提高印度HCC治疗标准的关键.
