Yau Thomas, Tai David, Chan Stephen Lam, Huang Yi-Hsiang, Choo Su Pin, Hsu Chiun, Cheung Tan To, Lin Shi-Ming, Yong Wei Peng, Lee Joycelyn, Leung Thomas, Shum Tracy, Yeung Cynthia S Y, Tai Anna Yin-Ping, Law Ada Lai Yau, Cheng Ann-Lii, Chen Li-Tzong
Department of Medicine, The University of Hong Kong, Hong Kong, China.
Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Liver Cancer. 2022 Jun 17;11(5):426-439. doi: 10.1159/000525582. eCollection 2022 Sep.
Asia has a high burden of hepatocellular carcinoma (HCC) due to the high rates of chronic hepatitis B infection and accounts for 70% of HCC cases globally. In the past 20 years, the systemic treatment landscape of advanced HCC has evolved substantially - from tyrosine kinase inhibitors to immune-oncology agents plus anti-vascular endothelial growth factor agents. The appropriate sequence of therapies has become critical in optimizing patient outcomes given the increase in systemic therapeutic options. This article evaluates the evidence and provides expert recommendations for the use of systemic therapies after first-line treatment in patients with advanced HCC.
Based on three virtual meetings held in early 2021, a team of 17 experts comprising oncologists, a hepatologist, and a hepatobiliary surgeon from Hong Kong, Singapore, and Taiwan reviewed available data about systemic treatments for HCC after first line and formulated 28 statements. These statements aimed to provide expert guidance on selecting first and subsequent lines of therapies as well as recommending therapies in special circumstances, such as poor liver function, posttransplantation, recent gastrointestinal bleeding, or autoimmune diseases. Data supporting the statements were drawn from clinical trials and real-world studies. The 28 statements were then evaluated anonymously using a 5-point Likert scale, and 24 reached consensus, predefined as achieving 75% agreement. Statements generated covered the selection of first-line systemic therapy, considerations and goals of second-line systemic therapies, treatment selection following first-line therapy, and treatment recommendations following first-line tyrosine kinase inhibitors, immune-oncology monotherapy, or immune-oncology combination therapy. The authors also shared expert opinion on the use of second-line systemic therapy in patients with liver dysfunction, liver transplantation, and recent gastrointestinal or autoimmune disease.
These expert statements summarize the latest data and expert opinion on selecting systemic treatment following first-line therapy in patients with unresectable advanced or metastatic HCC.
由于慢性乙型肝炎感染率高，亚洲肝细胞癌（HCC）负担沉重，占全球HCC病例的70%。在过去20年中，晚期HCC的全身治疗格局发生了重大变化——从酪氨酸激酶抑制剂到免疫肿瘤药物加抗血管内皮生长因子药物。鉴于全身治疗选择的增加，适当的治疗顺序对于优化患者预后至关重要。本文评估了相关证据，并为晚期HCC患者一线治疗后的全身治疗使用提供专家建议。
基于2021年初举行的三次虚拟会议，由来自香港、新加坡和台湾的肿瘤学家、肝病学家和肝胆外科医生组成的17名专家团队回顾了一线治疗后HCC全身治疗的可用数据，并制定了28条声明。这些声明旨在为选择一线和后续治疗方案以及在特殊情况下（如肝功能差、移植后、近期胃肠道出血或自身免疫性疾病）推荐治疗方案提供专家指导。支持这些声明的数据来自临床试验和真实世界研究。然后使用5点李克特量表对这28条声明进行匿名评估，其中24条达成共识，预定义为达成75%的一致意见。生成的声明涵盖一线全身治疗的选择、二线全身治疗的考虑因素和目标、一线治疗后的治疗选择以及一线酪氨酸激酶抑制剂、免疫肿瘤单药治疗或免疫肿瘤联合治疗后的治疗建议。作者还分享了关于肝功能不全、肝移植以及近期胃肠道或自身免疫性疾病患者使用二线全身治疗的专家意见。
这些专家声明总结了关于不可切除的晚期或转移性HCC患者一线治疗后选择全身治疗的最新数据和专家意见。
