Chen Qi-Feng, Chen Song, Jiang Xiong-Ying, Zhao Ming
Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
J Immunother Cancer. 2025 Aug 12;13(8):e012560. doi: 10.1136/jitc-2025-012560.
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, with systemic therapies constituting the cornerstone of treatment for advanced-stage disease. While lenvatinib has been a widely used first-line agent, the advent of immunotherapy-particularly combinations such as atezolizumab-bevacizumab and the durvalumab plus tremelimumab (STRIDE regimen)-has redefined the therapeutic landscape. Recent retrospective and real-world studies have yielded conflicting results regarding the comparative effectiveness of lenvatinib and immunotherapy. Rimini noted a survival benefit for lenvatinib in HCC, though real-world studies meta-analysis showed similar survival outcomes to atezolizumab-bevacizumab, while Ahn , via target trial emulation, reported better outcomes with immunotherapy. However, limitations such as lack of key clinical variables, heterogeneous treatment regimens, and residual confounding complicate interpretation. These findings highlight the need for prospective, etiology-stratified research with comprehensive clinical data to optimize first-line therapy selection and inform personalized treatment strategies in advanced HCC.
肝细胞癌（HCC）仍然是全球癌症相关死亡的主要原因，全身治疗是晚期疾病治疗的基石。虽然仑伐替尼一直是广泛使用的一线药物，但免疫疗法的出现——特别是阿替利珠单抗-贝伐单抗联合疗法以及度伐利尤单抗联合曲美木单抗（STRIDE方案）——重新定义了治疗格局。最近的回顾性研究和真实世界研究对于仑伐替尼和免疫疗法的相对有效性得出了相互矛盾的结果。里米尼指出仑伐替尼对HCC有生存获益，尽管真实世界研究的荟萃分析显示其生存结果与阿替利珠单抗-贝伐单抗相似，而安通过目标试验模拟报告免疫疗法有更好的结果。然而，诸如缺乏关键临床变量、治疗方案异质性和残余混杂因素等局限性使解读变得复杂。这些发现凸显了开展前瞻性、病因分层研究并提供全面临床数据的必要性，以优化一线治疗选择并为晚期HCC的个性化治疗策略提供依据。
