Biondetti Pierpaolo, Saggiante Lorenzo, Ierardi Anna Maria, Iavarone Massimo, Sangiovanni Angelo, Pesapane Filippo, Fumarola Enrico Maria, Lampertico Pietro, Carrafiello Gianpaolo
Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy.
Cancers (Basel). 2021 Nov 18;13(22):5797. doi: 10.3390/cancers13225797.
Image-guided locoregional therapies (LRTs) are a crucial asset in the treatment of hepatocellular carcinoma (HCC), which has proven to be characterized by an impaired antitumor immune status. LRTs not only directly destroy tumor cells but also have an immunomodulating role, altering the tumor microenvironment with potential systemic effects. Nevertheless, the immune activation against HCC induced by LRTs is not strong enough on its own to generate a systemic significant antitumor response, and it is incapable of preventing tumor recurrence. Currently, there is great interest in the possibility of combining LRTs with immunotherapy for HCC, as this combination may result in a mutually beneficial and synergistic relationship. On the one hand, immunotherapy could amplify and prolong the antitumoral immune response of LRTs, reducing recurrence cases and improving outcome. On the other hand, LTRs counteract the typical immunosuppressive HCC microenvironment and status and could therefore enhance the efficacy of immunotherapy. Here, after reviewing the current therapeutic options for HCC, we focus on LRTs, describing for each of them the technique and data on its effect on the immune system. Then, we describe the current status of immunotherapy and finally report the recently published and ongoing clinical studies testing this combination.
图像引导下的局部区域治疗（LRTs）是肝细胞癌（HCC）治疗中的一项关键手段，事实证明，HCC的特征是抗肿瘤免疫状态受损。LRTs不仅能直接破坏肿瘤细胞，还具有免疫调节作用，可改变肿瘤微环境并产生潜在的全身效应。然而，LRTs单独诱导的针对HCC的免疫激活本身不够强大，无法产生显著的全身抗肿瘤反应，也无法预防肿瘤复发。目前，人们对将LRTs与HCC免疫疗法联合使用的可能性非常感兴趣，因为这种联合可能会产生互利和协同的关系。一方面，免疫疗法可以放大和延长LRTs的抗肿瘤免疫反应，减少复发病例并改善治疗效果。另一方面，LTRs可对抗典型的免疫抑制性HCC微环境和状态，因此可以提高免疫疗法的疗效。在此，在回顾了目前HCC的治疗选择后，我们重点关注LRTs，描述每种LRTs的技术及其对免疫系统影响的数据。然后，我们描述免疫疗法的现状，最后报告最近发表的以及正在进行的测试这种联合疗法的临床研究。
