Department of Internal Medicine, The Ohio State University Wexner Medical Center The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Expert Opin Investig Drugs. 2022 Jul;31(7):693-706. doi: 10.1080/13543784.2022.2079491. Epub 2022 May 26.
Hepatocellular carcinoma (HCC) is a major health problem worldwide with limited systemic therapy options. Since the approval of sorafenib in 2008, no systemic therapy has provided a sustained/robust/survival benefit for patients with advanced HCC until recently. Many initially promising therapies have been trialed, but survival outcomes remained stagnant. Knowledge concerning previous treatment failures may help inform future therapeutic approaches.
This article reviews recent advances in the treatment of HCC. Despite some recent success, many systemic and locoregional therapies have failed to produce significant improvements in outcome. These treatment failures are examined and insight into pathways for future success are discussed.
Combination atezolizumab and bevacizumab has changed the landscape of systemic treatment for patients with HCC when it became the first therapy after demonstrating improve outcomes over sorafenib. Clinical trials in patients with advanced HCC have inherent difficulty with challenges to determine if a patient's declining liver function is secondary to disease progression, worsening cirrhosis, or drug toxicity, which may skew results. As we gain more knowledge of underlying genetic alterations behind the pathophysiology of the development of HCC, molecular markers may be identified to assist in predicting which patients would respond to a specific therapy.
肝细胞癌（HCC）是全球范围内的一个主要健康问题，其系统治疗选择有限。自 2008 年索拉非尼获得批准以来，直到最近，没有任何系统治疗能为晚期 HCC 患者提供持续/稳健/生存获益。许多最初有前途的疗法已经进行了试验，但生存结果仍然停滞不前。了解以前的治疗失败可能有助于为未来的治疗方法提供信息。
本文综述了 HCC 治疗的最新进展。尽管最近取得了一些成功，但许多系统和局部区域治疗方法未能在结果上取得显著改善。这些治疗失败被检查，并探讨了未来成功的途径。
当阿替利珠单抗联合贝伐珠单抗显示出优于索拉非尼的疗效，成为 HCC 患者的一线治疗药物时，改变了 HCC 的系统治疗格局。晚期 HCC 患者的临床试验存在固有困难，难以确定患者肝功能下降是疾病进展、肝硬化恶化还是药物毒性引起的，这可能会扭曲结果。随着我们对 HCC 发展的病理生理学背后潜在遗传改变的了解不断增加，可能会确定分子标志物，以帮助预测哪些患者对特定治疗有反应。
