Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Department of Medicine I, University Medical Center Schleswig-Holstein, Lübeck, Germany.
Aliment Pharmacol Ther. 2020 Jul;52(1):205-212. doi: 10.1111/apt.15789. Epub 2020 May 20.
Hepatocellular carcinoma (HCC) is one of the most lethal cancers. After many years of stagnation, there are now several systemic treatments available for patients with HCC.
To analyse the feasibility and efficacy of sequential systemic treatments in patients with HCC in clinical practice.
In this multicentre study, patients who were treated with novel systemic therapies for HCC between 2014 and 2019 at two referral centres, Hannover Medical School, Germany, and Medical University of Vienna, Austria, were included.
Overall, 85 patients were included of which 76 patients (89.4%) received more than one and a maximum of five systemic treatment lines. The most common therapy sequence was sorafenib (n = 72; 84.7%) followed by regorafenib (n = 37; 48.7%), whereas 11 patients were initially treated with lenvatinib (12.9%). Other second-line treatments included pembrolizumab, nivolumab, cabozantinib and ramucirumab. Hepatic function deteriorated during sequential systemic treatment in 48.6% of the patients as defined by an increase in at least one Child-Pugh point. Median overall survival (mOS) from the start of first systemic treatment was 35 months for patients with sequential systemic treatment compared to 9 months for patients with one systemic treatment line (P < 0.001). Patients previously treated with surgical/locoregional therapies had a longer mOS compared to patients with initial systemic treatment (66 vs 25 months; P = 0.020).
Sequential systemic treatment is feasible and effective in selected patients with HCC in clinical practice. Our study underlines the critical importance of well-preserved liver function for successful administration of sequential systemic therapy.
肝细胞癌（HCC）是最致命的癌症之一。经过多年的停滞不前，现在有几种系统治疗方法可用于 HCC 患者。
分析 HCC 患者临床实践中序贯系统治疗的可行性和疗效。
在这项多中心研究中，纳入了 2014 年至 2019 年期间在德国汉诺威医学院和奥地利维也纳医科大学的两个转诊中心接受新型 HCC 系统治疗的患者。
共有 85 名患者入选，其中 76 名患者（89.4%）接受了一种以上且最多五种系统治疗线。最常见的治疗方案是索拉非尼（n=72；84.7%），其次是regorafenib（n=37；48.7%），而 11 名患者最初接受 lenvatinib（12.9%）治疗。其他二线治疗包括 pembrolizumab、nivolumab、cabozantinib 和 ramucirumab。在序贯系统治疗期间，48.6%的患者肝功能恶化，定义为至少增加一个 Child-Pugh 点。与接受一线系统治疗的患者相比，接受序贯系统治疗的患者从首次系统治疗开始的中位总生存期（mOS）为 35 个月（P<0.001）。与初始系统治疗患者相比，先前接受手术/局部区域治疗的患者 mOS 更长（66 个月 vs 25 个月；P=0.020）。
序贯系统治疗在临床实践中对选定的 HCC 患者是可行且有效的。我们的研究强调了保持良好肝功能对序贯系统治疗成功的重要性。
