Malone Christopher D, Bajaj Suryansh, He Aiwu, Mody Kabir, Hickey Ryan M, Sarwar Ammar, Krishnan Sunil, Patel Tushar C, Toskich Beau B
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Vasc Interv Radiol. 2025 Mar;36(3):414-424.e2. doi: 10.1016/j.jvir.2024.11.012. Epub 2024 Nov 23.
Hepatocellular carcinoma is a leading and increasing contributor to cancer-related death worldwide. Recent advancements in both liver-directed therapies in the form of yttrium-90 (Y) radioembolization (RE) and systemic therapy in the form of immune checkpoint inhibitors (ICI) have expanded treatment options for patients with an otherwise poor prognosis. Despite these gains, ICIs and Y-RE each have key limitations with low objective response rates and persistent hazard of out-of-field recurrence, respectively, and overall survival remains low. However, each therapy's strength may mitigate the other's weakness, making them potentially ideal partners for combination treatment strategies. This review discusses the scientific and clinical rationale for combining Y-RE with ICIs, highlights early clinical trial data on its safety and effectiveness, and proposes key issues to be addressed in this emerging field. With optimal strategies, combination therapies can potentially result in increasing likelihood of durable and curative outcomes in later stage patients.
肝细胞癌是全球癌症相关死亡的主要且日益增加的原因。以钇-90（Y）放射性栓塞（RE）形式的肝脏定向治疗和以免疫检查点抑制剂（ICI）形式的全身治疗的最新进展，为预后较差的患者扩大了治疗选择。尽管取得了这些进展，但ICI和Y-RE分别存在关键局限性，即客观缓解率低和野外复发的持续风险，总体生存率仍然很低。然而，每种疗法的优势可能会减轻另一种疗法的劣势，使其成为联合治疗策略的潜在理想伙伴。本综述讨论了将Y-RE与ICI联合使用的科学和临床依据，强调了关于其安全性和有效性的早期临床试验数据，并提出了在这个新兴领域需要解决的关键问题。通过优化策略，联合疗法有可能提高晚期患者实现持久治愈结果的可能性。
