Department of Hepatology, Southampton General Hospital, University Hospital Southampton, Southampton SO16 6YD, United Kingdom.
Department of Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, United Kingdom.
World J Gastroenterol. 2019 Jun 28;25(24):2977-2989. doi: 10.3748/wjg.v25.i24.2977.
Hepatocellular carcinoma (HCC) arises on the background of chronic liver disease. Despite the development of effective anti-viral therapeutics HCC is continuing to rise, in part driven by the epidemic of non-alcoholic fatty liver disease. Many patients present with advanced disease out with the criteria for transplant, resection or even locoregional therapy. Currently available therapeutics for HCC are effective in a small minority of individuals. However, there has been a major global interest in immunotherapies for cancer and although HCC has lagged behind other cancers, great opportunities now exist for treating HCC with newer and more sophisticated agents. Whilst checkpoint inhibitors are at the forefront of this revolution, other therapeutics such as inhibitory cytokine blockade, oncolytic viruses, adoptive cellular therapies and vaccines are emerging. Broadly these may be categorized as either boosting existing immune response or stimulating de novo immune response. Although some of these agents have shown promising results as monotherapy in early phase trials it may well be that their future role will be as combination therapy, either in combination with one another or in combination with treatment modalities such as locoregional therapy. Together these agents are likely to generate new and exciting opportunities for treating HCC, which are summarized in this review.
肝细胞癌 (HCC) 发生在慢性肝病的背景下。尽管有效的抗病毒治疗方法不断发展，但 HCC 仍在继续上升，部分原因是非酒精性脂肪性肝病的流行。许多患者的疾病已发展到超出移植、切除甚至局部治疗标准的晚期。目前 HCC 的治疗方法在少数个体中有效。然而，癌症的免疫疗法在全球范围内引起了极大关注，尽管 HCC 落后于其他癌症，但现在有很多机会使用更新、更复杂的药物来治疗 HCC。虽然检查点抑制剂处于这一革命的前沿，但其他疗法，如抑制性细胞因子阻断、溶瘤病毒、过继细胞疗法和疫苗，也正在出现。这些疗法大致可分为增强现有免疫反应或刺激新的免疫反应。尽管这些药物中的一些在早期临床试验中作为单一疗法显示出有希望的结果，但它们未来的作用很可能是联合治疗，无论是彼此联合还是与局部治疗等治疗方式联合。这些药物联合起来可能为治疗 HCC 带来新的令人兴奋的机会，本文对此进行了总结。
