Challenges of advanced hepatocellular carcinoma.
Challenges of advanced hepatocellular carcinoma.
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晚期肝细胞癌的挑战。
DOI：
10.3748/wjg.v22.i34.7645
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发表时间：
2016-09-14
影响因子：
4.3
通讯作者：
Marra F
中科院分区：
文献类型：
--
作者：
Colagrande S;Inghilesi AL;Aburas S;Taliani GG;Nardi C;Marra F
肝细胞癌（HCC）是一种侵袭性的恶性肿瘤，是每年第三位的癌症死亡原因。HCC患者的管理是复杂的，因为肿瘤分期和任何潜在的肝脏疾病都必须联合考虑。尽管常规进行影像学、临床和生化参数监测，但许多患有肝硬化的患者在首次诊断时具有晚期HCC。晚期HCC包括具有不同临床状况和放射学特征的异质性患者组，索拉非尼是根据巴塞罗那临床肝癌唯一批准的治疗。自从索拉非尼引入临床实践以来，几项III期临床试验未能证明索拉非尼在一线环境中的任何优效性。局部区域治疗也已被测试为一线治疗，但其在晚期HCC中的作用仍有争议。索拉非尼治疗失败后，没有单一药物或联合治疗显示会影响结局。因此，本综述将重点介绍晚期HCC患者的实验性治疗方法，并强调这些治疗方法的成功和失败以及未来发展的领域。在开发HCC治疗时，应考虑与基础慢性肝病相关的肝功能障碍患者的剂量限制性毒性和安全性特征等具体问题。最后，在未来的随机试验中，应确定可靠的、经验证的、可重复的替代终点以及预测性生物标志物。
Hepatocellular carcinoma (HCC) is an aggressive malignancy, resulting as the third cause of death by cancer each year. The management of patients with HCC is complex, as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging, clinical and biochemical parameters is routinely performed, a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice, several phase III clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Loco-regional therapies have also been tested as first line treatment, but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally, robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.
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6.7
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通讯作者：
Soo, K-C
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作者：
Cheng, Ann-Lii;Kang, Yoon-Koo;Guan, Zhongzhen
通讯作者：
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