University of California San Francisco School of Medicine, 533 Parnassus Avenue, San Francisco, CA, 94143, USA.
Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Curr Treat Options Oncol. 2024 Sep;25(9):1153-1162. doi: 10.1007/s11864-024-01247-8. Epub 2024 Aug 1.
Liver transplantation for hepatocellular carcinoma (HCC) remains an evolving field. Major challenges HCC transplant patients face today include liver organ donor shortages and the need for both better pre-transplant bridging/downstaging therapies and post-transplant HCC recurrence treatment options. The advent of immunotherapy and the demonstrated efficacy of immune checkpoint inhibitors in multiple solid tumors including advanced/unresectable HCC hold promise in expanding both the neoadjuvant and adjuvant HCC transplant treatment regimen, though caution is needed with these immune modulating agents leading up to and following transplant. New options for pre-transplant HCC management will expand access to this curative option as well as ensure patients have adequate control of their HCC prior to transplant to maximize the utility of a liver donor. Machine perfusion has been an active area of investigation in recent years and could expand the organ donor pool, helping address current liver donor shortages. Finally, additional HCC biomarkers such as AFP-L3 and DCP have shown promise in improving risk stratification of HCC patients. Together, these three recent advancements will likely alter HCC transplant guidelines in the coming years.
肝移植治疗肝细胞癌(HCC)仍然是一个不断发展的领域。目前 HCC 移植患者面临的主要挑战包括肝器官供体短缺,以及需要更好的移植前桥接/降期治疗和移植后 HCC 复发治疗选择。免疫疗法的出现以及免疫检查点抑制剂在多种实体肿瘤(包括晚期/不可切除 HCC)中的疗效已得到证实,有望扩大新辅助和辅助 HCC 移植治疗方案,尽管在移植前和移植后使用这些免疫调节剂时需要谨慎。新的 HCC 移植前管理选择将扩大这一治疗方案的可及性,并确保患者在移植前充分控制 HCC,以最大限度地发挥供肝的作用。近年来,机器灌注一直是一个活跃的研究领域,它可以扩大器官供体库,有助于解决目前的肝供体短缺问题。最后,AFP-L3 和 DCP 等其他 HCC 生物标志物在改善 HCC 患者的风险分层方面显示出了希望。这三个最近的进展可能会在未来几年改变 HCC 移植指南。