Cui Tian-Ming, Liu Yao, Wang Jia-Bei, Liu Lian-Xin
Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China.
Onco Targets Ther. 2020 Nov 16;13:11725-11740. doi: 10.2147/OTT.S279858. eCollection 2020.
Immune-modulatory therapy, especially with immune-checkpoint inhibitors (ICIs), has reshaped cancer therapeutics. Immunotherapy is relatively a novel approach that can effectively delay the progression of aggressive tumors and inhibit tumor recurrence and metastasis in many different tumor types. In the past years, ICIs have shown a sustained response and promising long-term survival in patients with advanced hepatocellular carcinoma (HCC). Nevertheless, ICI therapy can unbalance the immune system and result in a wide range of immune-related adverse events (irAEs), which are generally manageable but occasionally lead to a fatal outcome. HCC generally develops in the context of liver cirrhosis which is typically caused by viral hepatitis and non-alcoholic steatohepatitis. These underlying diseases may cause symptoms that overlap with irAEs and lead to consequences such as late recognition, inadequate work-up, and inappropriate treatment. Owing to the growing use of immunotherapy in HCC, it is necessary for clinicians to strengthen their understanding of the frequency, clinical features, and management of irAEs. This review focuses on the common toxicities associated with ICI therapy in patients with HCC and summarizes therapeutic strategies that can be used to monitor and manage such toxicities.
免疫调节疗法，尤其是使用免疫检查点抑制剂（ICI），已经重塑了癌症治疗方法。免疫疗法是一种相对较新的方法，能够有效延缓侵袭性肿瘤的进展，并抑制多种不同肿瘤类型中的肿瘤复发和转移。在过去几年中，ICI在晚期肝细胞癌（HCC）患者中显示出持续的疗效和有希望的长期生存率。然而，ICI治疗可能会使免疫系统失衡，并导致广泛的免疫相关不良事件（irAE），这些不良事件通常是可控的，但偶尔会导致致命后果。HCC通常在肝硬化的背景下发生，而肝硬化通常由病毒性肝炎和非酒精性脂肪性肝炎引起。这些基础疾病可能会导致与irAE重叠的症状，并导致诸如识别延迟、检查不足和治疗不当等后果。由于免疫疗法在HCC中的使用日益增加，临床医生有必要加强对irAE的发生率、临床特征和管理的了解。本综述重点关注HCC患者中与ICI治疗相关的常见毒性，并总结可用于监测和管理此类毒性的治疗策略。
