Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, China.
Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, China.
Int J Mol Sci. 2023 Aug 30;24(17):13486. doi: 10.3390/ijms241713486.
Hepatocellular carcinoma (HCC), a highly malignant digestive system tumor, poses substantial challenges due to its intricate underlying causes and pronounced post-surgery recurrence. Consequently, the prognosis for HCC remains notably unfavorable. The endorsement of sorafenib and PD-L1 inhibitors for HCC signifies the onset of a new era embracing immunotherapy and targeted treatment approaches for this condition. Hence, comprehending the mechanisms underpinning targeted immune combination therapy has become exceedingly vital for the prospective management of HCC patients. This article initially presents a triumphant instance of curative treatment involving the combination of TKI and PD-1 inhibitor subsequent to liver resection, targeting an advanced stage HCC as classified by the BCLC staging system. The case patient carries a decade-long history of hepatitis B, having undergone a regimen of 20 courses of treatments involving apatinib and camrelizumab. Throughout the treatment period, no occurrences of grade 3 or 4 adverse events (AE) were noted. Subsequently, the patient underwent a left hepatectomy. Following the hepatectomy, their serum AFP levels have consistently remained within normal limits, and CT imaging has indicated the absence of tumor recurrence over a span of 36 months. The patient had been reviewed on time for two years after the operation. The last time a CT was performed for this patient in our hospital was 7 May 2021, and no new tumors were found. Follow-up is still ongoing. When applying combined targeted immune transformation therapy using TKI and ICI for a patient with BCLC advanced stage HCC, apatinib treatment serves a dual purpose. It inhibits the survival and angiogenesis of tumor cells, while also enhancing the efficacy of camrelizumab in obstructing the interaction between PD-1 and PD-L1. This restoration of T cell cytotoxicity subsequently facilitates the elimination of tumor cells, leading to an enhanced anticancer effect.
肝细胞癌（HCC）是一种高度恶性的消化系统肿瘤，由于其复杂的潜在原因和明显的术后复发，因此带来了很大的挑战。因此，HCC 的预后仍然非常不利。索拉非尼和 PD-L1 抑制剂被批准用于 HCC，标志着免疫治疗和靶向治疗方法开始应用于该疾病，这是一个新时代的开始。因此，了解靶向免疫联合治疗的机制对于 HCC 患者的未来管理变得至关重要。本文首先介绍了一个成功的治疗实例，即 TKI 和 PD-1 抑制剂联合治疗 BCLC 分期系统晚期 HCC 患者，该患者患有乙型肝炎长达 10 年，接受了阿帕替尼和卡瑞利珠单抗联合治疗 20 个疗程。在整个治疗期间，未发生 3 级或 4 级不良事件（AE）。随后，患者接受了左半肝切除术。肝切除术后，患者的血清 AFP 水平一直保持在正常范围内，CT 影像学检查显示 36 个月内无肿瘤复发。术后两年内患者按时复查。患者最后一次在我院行 CT 检查是在 2021 年 5 月 7 日，未发现新的肿瘤。目前仍在随访中。对于 BCLC 晚期 HCC 患者，TKI 和 ICI 联合靶向免疫转化治疗时，阿帕替尼治疗具有双重作用。它可以抑制肿瘤细胞的存活和血管生成，同时增强卡瑞利珠单抗阻断 PD-1 和 PD-L1 相互作用的效果。这种 T 细胞细胞毒性的恢复随后促进了肿瘤细胞的消除，从而增强了抗癌效果。
