肝细胞癌免疫检查点抑制剂治疗失败后的二线治疗:酪氨酸激酶抑制剂、免疫治疗的再试验,还是局部治疗?

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Liver Cancer Pub Date : 2023-11-13 DOI:10.1159/000534303
Sang Youn Hwang, Sangjune L. Lee, Hongqun Liu, Samuel S. Lee
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引用次数: 0

摘要

背景:最近的两项随机对照试验(rct) (IMbrave150, HIMALAYA)报道了基于免疫检查点抑制剂(ICI)的治疗方法,如atezolizumab加贝伐单抗或durvalumab加tremelimumab成为晚期肝细胞癌(HCC)患者的主流一线全身治疗,因为基于ICI的治疗方法与酪氨酸激酶抑制剂(TKI)相比显着优于TKI。然而,一线ci治疗失败后的最佳二线治疗仍然未知,因为没有RCT研究过这个问题。摘要:因此,目前大多数临床医生都是经验性地治疗TKIs患者,或者在没有确凿证据的情况下再试验ICI或局部区域治疗(LRT)方式,如经动脉治疗、射频消融和放射治疗。在这篇综述中,我们将通过回顾已发表的研究和正在进行的前瞻性试验,讨论目前一线ici治疗失败后二线治疗的最佳策略。关键信息:在这种情况下,临床医生应考虑肝功能储备、功能状态、既往治疗的不良事件以及是否存在可考虑LRT的病变(如少进展、血管侵犯等)等因素,慎重考虑是否采用TKI、其他基于ci的治疗或LRT。与此同时,我们等待正在进行的前瞻性试验的结果,以阐明最佳的管理选择。
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Second-Line Treatment after Failure of Immune Check Point Inhibitors in Hepatocellular Carcinoma: Tyrosine Kinase Inhibitor, Retrial of Immunotherapy, or Locoregional Therapy?
Background: Immune check point inhibitor (ICI)-based therapy such as atezolizumab plus bevacizumab or durvalumab plus tremelimumab became mainstream first-line systemic treatment in advanced hepatocellular carcinoma (HCC) patients since remarkably superior efficacy of ICI-based therapy compared to tyrosine kinase inhibitors (TKI) was reported in two recent randomized controlled trials (RCTs) (IMbrave150, HIMALAYA). However, the optimal second-line therapy after treatment failure of first-line ICI-based therapy remains unknown as no RCT has examined this issue. Summary: Therefore, at present most clinicians are empirically treating patients with TKIs or retrial of ICI or locoregional treatment (LRT) modality such as transarterial therapy, radiofrequency ablation, and radiation therapy in this clinical setting without solid evidence. In this review, we will discuss current optimal strategies for second-line treatment after the failure of first-line ICI-based therapy by reviewing published studies and ongoing prospective trials. Key Messages: Clinicians should consider carefully whether to treat the patients with TKI, other ICI-based therapy, or LRT in this situation by considering several factors including liver function reserve, performance status, adverse events of previous therapy, and presence of lesion that can consider LRT such as oligoprogression, vascular invasion, etc. In the meantime, we await the results of ongoing prospective trials to elucidate the best management options.
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来源期刊
Liver Cancer
Liver Cancer Medicine-Oncology
CiteScore
20.80
自引率
7.20%
发文量
53
审稿时长
16 weeks
期刊介绍: Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.
期刊最新文献
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