Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline
Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline
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DOI：
10.1200/jco.20.02672
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发表时间：
2020-12-20
影响因子：
45.3
通讯作者：
Rose, Michal G.
中科院分区：
文献类型：
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作者：
Gordan, John D.;Kennedy, Erin B.;Rose, Michal G.
为制定循证临床实践指南，以帮助晚期肝细胞癌(HCC)患者的临床决策。方法SASCO召集了一个专家小组，对已发表的关于系统治疗晚期肝癌的III期随机对照试验(2007-2020)进行系统审查，并为该患者群体提供推荐的护理方案。结果III期随机对照试验符合纳入标准。RECOMMENDATIONSAtezolizumab+Beveizumab(atezo+Bev)可作为大多数晚期肝癌患者的一线治疗方案，食道Child-Pugh A级肝病，东部合作肿瘤组表现状态(ECOG PS)0-1，以及静脉曲张的后续处理根据机构指导方针。在阿替唑单抗和/或贝伐单抗有禁忌症的情况下，酪氨酸激酶抑制剂索拉非尼或莱瓦替尼可作为晚期肝癌、Child-Pugh A类肝病和ECOG PS 0-1患者的一线治疗药物。在使用Tatezo+BEV一线治疗之后，在有更好的数据之前，可能会推荐适当的候选患者使用酪氨酸激酶抑制剂的二线治疗。在使用索拉非尼或lenvatinib进行一线治疗后，适用于合适候选患者的二线治疗方案包括Cabozantinib、适用于以前耐受过索拉非尼的患者的regorafenib或ramucirumab(适用于甲胎蛋白<400 ng/mL)，或作为一线治疗方案的患者无法获得此选项的阿泰佐+Bev。Pembrolizumab或nivolumab也是服用索拉非尼或lenvatinib的适当患者的合理选择。讨论了将nivolumab+ipilimumab作为二线和三线治疗方案的考虑。指南中包括了关于在治疗方案中进行选择的进一步指导。欲了解更多信息，请访问www.asco.org/gastrointestinal-cancer-guidelines.。
PURPOSETo develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with advanced hepatocellular carcinoma (HCC).METHODSASCO convened an Expert Panel to conduct a systematic review of published phase III randomized controlled trials (2007-2020) on systemic therapy for advanced HCC and provide recommended care options for this patient population.RESULTSNine phase III randomized controlled trials met the inclusion criteria.RECOMMENDATIONSAtezolizumab + bevacizumab (atezo + bev) may be offered as first-line treatment of most patients with advanced HCC, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1, and following management of esophageal varices, when present, according to institutional guidelines. Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC, Child-Pugh class A liver disease, and ECOG PS 0-1. Following first-line treatment with atezo + bev, and until better data are available, second-line therapy with a tyrosine kinase inhibitor may be recommended for appropriate candidates. Following first-line therapy with sorafenib or lenvatinib, second-line therapy options for appropriate candidates include cabozantinib, regorafenib for patients who previously tolerated sorafenib, or ramucirumab (for patients with alpha -fetoprotein >= 400 ng/mL), or atezo + bev where patients did not have access to this option as first-line therapy. Pembrolizumab or nivolumab are also reasonable options for appropriate patients following sorafenib or lenvatinib. Consideration of nivolumab + ipilimumab as an option for second-line therapy and third-line therapy is discussed. Further guidance on choosing between therapy options is included within the guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.