Abou-Alfa Ghassan K, Venook Alan P
Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA.
Curr Oncol Rep. 2008 May;10(3):199-205. doi: 10.1007/s11912-008-0031-x.
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, causing 500,000 deaths yearly. The risk factors mostly responsible for the rising incidence of HCC in the Western hemisphere are hepatitis C, alcoholic cirrhosis, and nonalcoholic steatohepatitis, which most commonly leads to HCC in the setting of cirrhosis. Over the past 30 years, several chemotherapeutic single agents and combinations have been tested in HCC, yet none have demonstrated any improvement in survival. Recently, the multitargeted anti-angiogenic and Raf kinase inhibitor sorafenib has shown a survival advantage as a single agent and improved outcomes in combination with doxorubicin. Other novel agents have also shown intriguing outcomes as single agents (sunitinib) or in combination (bevacizumab and erlotinib). The encouraging results and clinical information gathered in recent trials are generating important clinical questions regarding which patients to treat, how to accommodate concurrent cirrhosis, and which parameters to use to monitor efficacy and the potential benefit from therapy.
肝细胞癌（HCC）是全球第五大常见癌症，每年导致50万人死亡。在西半球，导致HCC发病率上升的主要危险因素是丙型肝炎、酒精性肝硬化和非酒精性脂肪性肝炎，其中非酒精性脂肪性肝炎在肝硬化背景下最常导致HCC。在过去30年里，几种化疗单药和联合用药方案都在HCC中进行了测试，但没有一种方案能提高生存率。最近，多靶点抗血管生成和Raf激酶抑制剂索拉非尼作为单药显示出了生存优势，与阿霉素联合使用时也改善了治疗效果。其他新型药物作为单药（舒尼替尼）或联合用药（贝伐单抗和厄洛替尼）也显示出了有趣的结果。近期试验中获得的令人鼓舞的结果和临床信息引发了一些重要的临床问题，比如该治疗哪些患者、如何应对并存的肝硬化，以及用哪些参数来监测疗效和治疗的潜在获益。
