Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, MA.
Massachusetts General Hospital, Division of Hematology-Oncology, Department of Medicine, Harvard Medical School, Boston, MA.
Semin Radiat Oncol. 2018 Oct;28(4):332-341. doi: 10.1016/j.semradonc.2018.06.006.
The majority of patients with hepatocellular carcinoma (HCC) present with advanced disease. While first-line therapy with sorafenib is considered standard of care for patients with advancedHCC, outcomes remain poor. Despite early evidence of antitumor activity from Phase II trials of multiple other tyrosine kinase inhibitors, Phase III trials have largely failed to show an improvement insurvival outcomes over sorafenib. Given the encouraging early results with liver-directed radiotherapy for patients with advanced HCC, there is an increased interest in combination of these therapies tooptimize patient outcomes and improve survival by maximizing both local and distant disease control. Phase II trials of checkpoint inhibitors in HCC have also reported encouraging results, and Phase IIItrials are ongoing. Trials of combining radiotherapy with immunotherapy in solid tumors have shown intriguing results, potentially reflecting the opportunity for synergistic effects with the use of both modalities.
大多数肝细胞癌 (HCC) 患者就诊时已处于晚期。索拉非尼作为晚期 HCC 的标准一线治疗方法，但其治疗效果仍不理想。尽管在多项其他酪氨酸激酶抑制剂的 II 期临床试验中早期观察到抗肿瘤活性，但 III 期临床试验在总生存结果方面大多未能显示出优于索拉非尼的改善。鉴于晚期 HCC 患者接受肝定向放疗的早期结果令人鼓舞，人们越来越关注这些疗法的联合应用，以优化患者的治疗效果并通过最大限度地控制局部和远处疾病来提高生存率。HCC 中检查点抑制剂的 II 期临床试验也报告了令人鼓舞的结果，III 期临床试验正在进行中。在实体瘤中放疗与免疫治疗联合的临床试验结果也很有趣，这可能反映了这两种治疗方式联合应用具有协同作用的机会。
