不可切除肝细胞癌的经肝动脉化疗栓塞术联合靶向药物或程序性死亡受体1及其配体单抗治疗进展

Abstract

经肝动脉化疗栓塞术(TACE)被国内外指南推荐用于不可切除肝细胞癌(uHCC)患者的治疗，是uHCC患者最常用的治疗方法之一。TACE治疗HCC常用的化疗药物包括表柔比星、顺铂、氟尿嘧啶等，不过哪种化疗药物更优效还不清楚。本文总结了近5年关于使用不同化疗药物的TACE方案治疗uHCC患者的研究。TACE联合索拉非尼显著改善中晚期HCC患者的生存，已被中国临床肿瘤学会指南推荐用于这类患者，TACE联合其他酪氨酸激酶抑制剂(TKI)的疗效也成为研究热点。研究提示TACE联合仑伐替尼较TACE联合索拉非尼治疗晚期HCC患者的中位无进展生存期显著更高、中位总生存期有提高的趋势。而由于靶受体或下游信号的变异，分子靶向药物耐药仍然是一个挑战性问题。TKI结合免疫检查点抑制剂的治疗对uHCC患者可能是一个有希望的策略。一些研究初步提示TACE联合TKI及程序性死亡受体1及程序性死亡受体及其配体(PD-1/PD-L1)单抗的三联治疗在改善uHCC患者生存方面有较佳的疗效。本文综述了近5年TACE联合靶向药物、TACE联合PD-1/PD-L1单抗治疗uHCC患者的疗效与安全性研究。

Alternate abstract:

Transcatheter arterial chemoembolization (TACE) is recommended by domestic and international guidelines for the treatment of patients with unresectable hepatocellular carcinoma (uHCC), and it is one of the most common treatment methods for patients with uHCC. The chemotherapy drugs commonly used in TACE for HCC include epirubicin, cisplatin, and fluorouracil, while it is still unclear which chemotherapy drug has a better clinical effect. This article summarizes the studies of different TACE regimens using different chemotherapy drugs in the treatment of patients with uHCC in the recent five years. TACE combined with sorafenib can significantly improve the survival of patients with advanced HCC and has been recommended for the treatment of such patients by Chinese Society of Clinical Oncology guidelines, and the efficacy of TACE combined with other tyrosine kinase inhibitors (TKI) has become a research hotspot. Studies have shown that compared with TACE combined with sorafenib in the treatment of patients with advanced HCC, TACE combined with lenvatinib can achieve a significantly longer progression-free survival time and a tendency of increase in median overall survival time. However, due to the variation of target receptors or downstream signals, resistance to molecular-targeted agents is still a challenging problem. TKI combined with immune checkpoint inhibitors may be a promising strategy for the treatment of patients with uHCC. Some studies suggest that triple therapy using TACE combined with TKIs and anti-PD-1/PD-L1 monoclonal antibody has better efficacy in improving the survival of patients with uHCC. This article reviews the studies of the efficacy and safety of TACE combined with targeted agents and TACE combined with anti-PD-1/PD-L1 monoclonal antibody in the treatment of patients with uHCC in the recent five years.