Saleh Yacob, Abu Hejleh Taher, Abdelrahim Maen, Shamseddine Ali, Chehade Laudy, Alawabdeh Tala, Mohamad Issa, Sammour Mohammad, Turfa Rim
Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan.
Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2024 May 30;16(11):2081. doi: 10.3390/cancers16112081.
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths. Classically, liver transplantation (LT) can be curative for HCC tumors within the Milan criteria. Bridging strategies to reduce the dropouts from LT waiting lists and/or to downstage patients who are beyond the Milan criteria are widely utilized. We conducted a literature-based review to evaluate the role of systemic therapies as a bridging treatment to liver transplantation (LT) in HCC patients. Tyrosine kinase inhibitors (TKIs) can be used as a systemic bridging therapy to LT in patients with contraindications for locoregional liver-directed therapies. Immune checkpoint inhibitor (ICI) treatment can be utilized either as a monotherapy or as a combination therapy with bevacizumab or TKIs prior to LT. Acute rejection after liver transplantation is a concern in the context of ICI treatment. Thus, a safe ICI washout period before LT and cautious post-LT immunosuppression strategies are required to reduce post-LT rejections and to optimize clinical outcomes. Nevertheless, prospective clinical trials are needed to establish definitive conclusions about the utility of systemic therapy as a bridging modality prior to LT in HCC patients.
肝细胞癌（HCC）是癌症相关死亡的第三大常见原因。传统上，肝移植（LT）可治愈符合米兰标准的HCC肿瘤。广泛采用了一些桥接策略，以减少LT等待名单上的退出人数和/或使超出米兰标准的患者降期。我们进行了一项基于文献的综述，以评估全身治疗作为HCC患者肝移植（LT）桥接治疗的作用。酪氨酸激酶抑制剂（TKIs）可作为局部区域肝脏定向治疗禁忌患者LT的全身桥接治疗。免疫检查点抑制剂（ICI）治疗可在LT前作为单一疗法或与贝伐单抗或TKIs联合使用。肝移植后的急性排斥反应是ICI治疗中的一个问题。因此，需要在LT前有一个安全的ICI洗脱期，并采取谨慎的LT后免疫抑制策略，以减少LT后排斥反应并优化临床结果。然而，需要进行前瞻性临床试验，以确定全身治疗作为HCC患者LT前桥接方式的效用的确切结论。
