Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
Orthopedics, Tianjin Medical University General Hospital, Tianjin, China.
Biosci Trends. 2022 Mar 11;16(1):31-45. doi: 10.5582/bst.2022.01044. Epub 2022 Feb 15.
Hepatic malignancies remain a global challenge. Hepatocellular carcinoma (HCC) accounts for around 90% of patients with liver cancer and is the sixth most common neoplasm worldwide and the fourth leading cause of cancer-related death. However, the long-term prognosis for HCC remains far from satisfactory, with a late diagnosis and limited treatment. DOX has served as conventional chemotherapy with the longest history of use. Although conventional chemotherapy is being challenged by molecular therapy and immune therapy, there is renewed optimism and interest in both systematic and locoregional therapy. Combined chemotherapy is widely used in clinical practice. In specific terms, FOLFOX can serve as a first-line (category 2B) option as recommended by the 2021 NCCN guidelines, while the efficacy of LTLD plus RFA has been confirmed in the phase III HEAT study. These approaches have challenged the dominant status of molecular therapy in terms of health economics and they have potential benefits in Asia, where HBV-related hepatocellular carcinoma is prevalent. Moreover, locoregional chemotherapy can be achieved with TACE and HAIC (possibly involving FOLFOX, DOX, mitomycin C, cisplatin, epirubicin, etc.). TACE was officially recommended by the 2021 NCCN guidelines for patients with Child-Pugh class B liver disease. In addition, HAIC has demonstrated a potential advantage in preliminary clinical practice, although it hasn't been included in any guidelines. Hence, this review summarizes large-scale trials and studies examining the development and innovative use of chemotherapeutic agents. Mounting clinical evidence warrants an exploration of the efficacy of chemotherapy.
肝脏恶性肿瘤仍然是一个全球性的挑战。肝细胞癌（HCC）占肝癌患者的 90%左右，是全球第六大常见肿瘤，也是癌症相关死亡的第四大主要原因。然而，HCC 的长期预后仍然远不能令人满意，诊断较晚，治疗方法有限。多柔比星（DOX）一直是传统化疗中使用历史最长的药物。尽管传统化疗正受到分子治疗和免疫治疗的挑战，但系统治疗和局部区域治疗又重新受到关注和重视。联合化疗在临床实践中广泛应用。具体来说，根据 2021 年 NCCN 指南的建议，FOLFOX 可作为一线（类别 2B）选择，而 LTLD 联合 RFA 的疗效已在 III 期 HEAT 研究中得到证实。这些方法在健康经济学方面对分子治疗的主导地位提出了挑战，在乙型肝炎病毒相关肝细胞癌高发的亚洲地区具有潜在的获益。此外，经导管动脉化疗栓塞术（TACE）和肝动脉灌注化疗（HAIC）也可实现局部区域化疗（可能涉及 FOLFOX、DOX、丝裂霉素 C、顺铂、表柔比星等）。2021 年 NCCN 指南正式推荐 TACE 用于肝功能 Child-Pugh 分级为 B 级的患者。此外，HAIC 在初步临床实践中显示出了潜在的优势，尽管它尚未被纳入任何指南。因此，本综述总结了评估化疗药物开发和创新应用的大规模临床试验和研究。越来越多的临床证据证明了化疗的疗效。
