Javan Hanna, Dayyani Farshid, Abi-Jaoudeh Nadine
Department of Radiological Sciences, University of California Irvine, Orange, California.
Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, California.
Semin Intervent Radiol. 2020 Dec;37(5):466-474. doi: 10.1055/s-0040-1719187. Epub 2020 Dec 11.
Treatment of advanced hepatocellular carcinoma (HCC) is challenging. Several randomized clinical trials are investigating the efficacy of systemic therapy, immunotherapy, and locoregional therapy as monotherapy or combined with other modalities in the treatment of HCC. Systemic therapy is the preferred treatment in advanced disease. To date, multiple first-line and second-line agents received Food and Drug Administration approval. For over a decade, sorafenib was the only first-line agent. In May 2020, combination of atezolizumab and bevacizumab has been approved as a first-line systemic regimen. Lenvatinib is another first-line agent that has multikinase activity. Second-line agents include cabozantinib, regorafenib, ramucirumab, and nivolumab. Adoptive cell transfer therapy is a highly specific immunotherapy that has shown antitumor activity against HCC. Oncolytic viruses are genetically modified viruses that infect cancer cells and induce apoptosis. Locoregional therapies such as transarterial chemoembolization and radioembolization have shown a potential benefit in selected patients with advanced HCC. In this review, we aim to summarize the treatment options available for advanced HCC.
晚期肝细胞癌（HCC）的治疗具有挑战性。多项随机临床试验正在研究全身治疗、免疫治疗和局部区域治疗作为单一疗法或与其他方式联合用于治疗HCC的疗效。全身治疗是晚期疾病的首选治疗方法。迄今为止，多种一线和二线药物已获得美国食品药品监督管理局（FDA）的批准。十多年来，索拉非尼一直是唯一的一线药物。2020年5月，阿替利珠单抗和贝伐单抗联合用药已被批准作为一线全身治疗方案。仑伐替尼是另一种具有多激酶活性的一线药物。二线药物包括卡博替尼、瑞戈非尼、雷莫西尤单抗和纳武单抗。过继性细胞转移疗法是一种高度特异性的免疫疗法，已显示出对HCC的抗肿瘤活性。溶瘤病毒是经过基因改造的病毒，可感染癌细胞并诱导其凋亡。经动脉化疗栓塞和放射性栓塞等局部区域治疗已在部分晚期HCC患者中显示出潜在益处。在本综述中，我们旨在总结晚期HCC可用的治疗选择。
