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肝细胞癌的生物学、流行病学、临床方面及索拉非尼的作用

Biology, Epidemiology, Clinical Aspects of Hepatocellular Carcinoma and the Role of Sorafenib.

作者信息

Mazzoccoli Gianluigi, Miele Luca, Oben Jude, Grieco Antonio, Vinciguerra Manlio

机构信息

Department of Medical Sciences, Division of Internal Medicine and Chronobiology Unit, IRCCS "Casa Sollievo della Sofferenza", Opera di Padre Pio da Pietrelcina, Cappuccini Av., San Giovanni Rotondo (FG), 71013, Italy.

出版信息

Curr Drug Targets. 2016;17(7):783-99. doi: 10.2174/1389450117666151209120831.

Abstract

Sorafenib is a small molecular inhibitor of intracellular tyrosine and serine/threonine protein kinases (VEGFR, PDGFR, CRAF and BRAF), and is thought also to induce autophagy, a chief mechanism influencing tumor growth. Sorafenib shows efficacy in the management of non-resectable hepatocellular carcinoma (HCC), which is refractory to other chemotherapeutic drugs. HCC represents a major end point of chronic liver diseases and the third leading cause of cancer-related death. In HCC patients Sorafenib increases overall survival compared to placebo. The most common chronic liver disease affecting up to 30% of the population in Western countries is non-alcoholic fatty liver disease (NAFLD), an intra-hepatic amassing of triglycerides deemed as the hepatic manifestation of insulin resistance and obesity. NAFLD encompasses a range of disorders with grades of liver damage varying from steatosis to non-alcoholic steatohepatitis (NASH), hallmarked by hepatocellular injury/inflammation in the presence or not of fibrosis. NAFLD patients progress to NASH in 10% of cases, which may progress to cirrhosis and HCC. Recent exciting studies uncovered a potential therapeutic role for Sorafenib that goes beyond HCC, and extends to cirrhotic portal hypertensive syndrome during cirrhosis, and to selective anti-fibrotic effects mediated through direct inhibition of activated hepatic stellate cells (HSC), the cellular mediators of intra-hepatic matrix deposition. The aim of this review is to concisely summarize our current knowledge of the biology, epidemiology and clinical aspects of HCC, as well as the previously under-appreciated therapeutic efficacy of Sorafenib beyond HCC. The review therefore utilizes data along the spectrum of liver diseases, including from experimental via pre-clinical to clinical.

摘要

索拉非尼是一种细胞内酪氨酸和丝氨酸/苏氨酸蛋白激酶(VEGFR、PDGFR、CRAF和BRAF)的小分子抑制剂,并且还被认为可诱导自噬,这是影响肿瘤生长的主要机制。索拉非尼在不可切除肝细胞癌(HCC)的治疗中显示出疗效,而HCC对其他化疗药物具有耐药性。HCC是慢性肝病的主要终点,也是癌症相关死亡的第三大主要原因。在HCC患者中,与安慰剂相比,索拉非尼可提高总生存率。在西方国家,影响高达30%人口的最常见慢性肝病是非酒精性脂肪性肝病(NAFLD),即肝内甘油三酯的积聚,被认为是胰岛素抵抗和肥胖的肝脏表现。NAFLD包括一系列疾病,肝损伤程度从脂肪变性到非酒精性脂肪性肝炎(NASH)不等,其特征是无论有无纤维化,均存在肝细胞损伤/炎症。10%的NAFLD患者会进展为NASH,后者可能进展为肝硬化和HCC。最近令人兴奋的研究发现索拉非尼具有潜在的治疗作用,其作用范围超出了HCC,还扩展到肝硬化期间的肝硬化门静脉高压综合征,以及通过直接抑制活化的肝星状细胞(HSC)介导的选择性抗纤维化作用,HSC是肝内基质沉积的细胞介质。本综述的目的是简要总结我们目前对HCC的生物学、流行病学和临床方面的认识,以及索拉非尼在HCC之外此前未得到充分认识的治疗效果。因此,本综述利用了从实验到临床前再到临床的一系列肝病数据。

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