Rimassa Lorenza, Personeni Nicola, Czauderna Carolin, Foerster Friedrich, Galle Peter
Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089 Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele (Milan), Italy.
Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089 Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele (Milan), Italy.
J Hepatol. 2021 Apr;74(4):931-943. doi: 10.1016/j.jhep.2020.11.026. Epub 2020 Nov 26.
Recent years have seen significant progress in the systemic treatment of hepatocellular carcinoma (HCC), including the advent of immunotherapy. While several large phase III trials have provided the evidence for a multi-line treatment paradigm, they have focused on a highly selected group of patients by excluding potentially confounding comorbidities. As a result, high quality evidence for the systemic treatment of HCC in patients with various comorbidities is missing. This review summarises current knowledge on the use of approved medicines in patients with HIV, autoimmune disease, cardiovascular disease, diabetes, fibrolamellar HCC, mixed HCC-cholangiocarcinoma, decompensated cirrhosis (Child-Pugh B and C), a significant bleeding history, vascular invasion or portal vein thrombosis, as well as the elderly, those on haemodialysis, and those after solid organ transplantation. The article highlights relevant knowledge gaps and current clinical challenges. To improve the safety and efficacy of HCC treatment in these subgroups, future trials should be designed to specifically include patients with comorbidities.
近年来，肝细胞癌（HCC）的系统治疗取得了重大进展，包括免疫疗法的出现。虽然几项大型III期试验为多线治疗模式提供了证据，但它们通过排除潜在的混杂合并症，聚焦于高度选择的患者群体。因此，缺乏关于各种合并症患者HCC系统治疗的高质量证据。本综述总结了目前关于HIV、自身免疫性疾病、心血管疾病、糖尿病、纤维板层型肝癌、混合性HCC-胆管癌、失代偿性肝硬化（Child-Pugh B级和C级）、有重大出血史、血管侵犯或门静脉血栓形成患者，以及老年人、接受血液透析的患者和实体器官移植后的患者使用已批准药物的知识。本文强调了相关的知识空白和当前的临床挑战。为提高这些亚组中HCC治疗的安全性和有效性，未来试验应设计为专门纳入合并症患者。
