Girardi Daniel M, Sousa Lara P, Miranda Thiago A, Haum Fernanda N C, Pereira Gabriel C B, Pereira Allan A L
Hospital Sírio-Libanes, SGAS 613/614 Conjunto E Lote 95-Asa Sul, Brasília 70200-730, Brazil.
Hospital de Base do Distrito Federal, SMHS-Área Especial, Q. 101-Asa Sul, Brasília 70330-150, Brazil.
Cancers (Basel). 2023 Mar 9;15(6):1680. doi: 10.3390/cancers15061680.
Hepatocellular carcinoma often develops in the context of chronic liver disease. It is the sixth most frequently diagnosed cancer and the third most common cause of cancer-related mortality worldwide. Although the mainstay of therapy is surgical resection, most patients are not eligible because of liver dysfunction or tumor extent. Sorafenib was the first tyrosine kinase inhibitor that improved the overall survival of patients who failed to respond to local therapies or had advanced disease, and for many years, it was the only treatment approved for the first-line setting. However, in recent years, trials have demonstrated an improvement in survival with treatments based on immunotherapy and new targeting agents, thereby extending the treatment options. A phase III trial showed that a combination of immunotherapy and targeted therapy, including atezolizumab plus bevacizumab, improved survival in the first-line setting, and is now considered the new standard of care. Other agents and combinations are being tested, including the combination of nivolumab plus ipilimumab and tremelimumab plus durvalumab, and they reportedly have clinical benefits. The aim of this manuscript is to review the latest approved therapeutic options in first- and second-line settings for advanced HCC and discuss future perspectives.
肝细胞癌通常在慢性肝病的背景下发生。它是全球第六大最常被诊断出的癌症，也是癌症相关死亡的第三大常见原因。尽管治疗的主要手段是手术切除，但由于肝功能障碍或肿瘤范围，大多数患者不符合条件。索拉非尼是第一种改善对局部治疗无反应或患有晚期疾病患者总生存期的酪氨酸激酶抑制剂，多年来，它是唯一被批准用于一线治疗的药物。然而，近年来，试验表明基于免疫疗法和新靶向药物的治疗可提高生存率，从而扩展了治疗选择。一项III期试验表明，免疫疗法和靶向疗法的联合使用，包括阿替利珠单抗加贝伐单抗，可提高一线治疗的生存率，现在被认为是新的护理标准。其他药物和联合疗法正在进行测试，包括纳武单抗加伊匹木单抗以及曲美木单抗加度伐利尤单抗的联合使用，据报道它们具有临床益处。本文的目的是回顾晚期肝癌一线和二线治疗中最新批准的治疗选择，并讨论未来前景。
