Sequential systemic treatment in patients with hepatocellular carcinoma
Sequential systemic treatment in patients with hepatocellular carcinoma
复制标题
DOI：
10.1111/apt.15789
复制
发表时间：
2020-05-20
影响因子：
7.6
通讯作者：
Vogel, Arndt
中科院分区：
文献类型：
--
作者：
Kirstein, Martha M.;Scheiner, Bernhard;Vogel, Arndt
背景肝细胞癌是最致命的癌症之一。目的分析临床上序贯系统治疗肝癌的可行性和有效性。方法在这项多中心研究中，纳入2014-2019年在德国汉诺威医学院和奥地利维也纳医科大学两个转诊中心接受新系统治疗的肝癌患者。最常见的治疗顺序是索拉非尼(n=72，84.7%)，其次是瑞格拉非尼(n=37，48.7%)，而11例患者最初使用lenvatinib(12.9%)。其他二线治疗包括Pembrolizumab、nivolumab、Cabozantinib和ramucirumab。在连续系统治疗期间，48.6%的患者肝功能恶化，定义为至少增加一个Child-Pugh评分。从第一次系统治疗开始，序贯系统治疗的患者的中位总生存期(MOS)为35个月，而单一系统治疗的患者为9个月(P<；0.001)。与初次全身治疗的患者相比，接受手术/局部治疗的患者的平均生存时间较长(66个月vs25个月；P=0.020)。结论序贯全身治疗在临床上是可行和有效的。我们的研究强调了良好保存的肝功能对于成功实施序贯系统治疗的关键重要性。
Background Hepatocellular carcinoma (HCC) is one of the most lethal cancers. After many years of stagnation, there are now several systemic treatments available for patients with HCC.Aim To analyse the feasibility and efficacy of sequential systemic treatments in patients with HCC in clinical practice.Methods In this multicentre study, patients who were treated with novel systemic therapies for HCC between 2014 and 2019 at two referral centres, Hannover Medical School, Germany, and Medical University of Vienna, Austria, were included.Results Overall, 85 patients were included of which 76 patients (89.4%) received more than one and a maximum of five systemic treatment lines. The most common therapy sequence was sorafenib (n = 72; 84.7%) followed by regorafenib (n = 37; 48.7%), whereas 11 patients were initially treated with lenvatinib (12.9%). Other second-line treatments included pembrolizumab, nivolumab, cabozantinib and ramucirumab. Hepatic function deteriorated during sequential systemic treatment in 48.6% of the patients as defined by an increase in at least one Child-Pugh point. Median overall survival (mOS) from the start of first systemic treatment was 35 months for patients with sequential systemic treatment compared to 9 months for patients with one systemic treatment line (P < 0.001). Patients previously treated with surgical/locoregional therapies had a longer mOS compared to patients with initial systemic treatment (66 vs 25 months; P = 0.020).Conclusion Sequential systemic treatment is feasible and effective in selected patients with HCC in clinical practice. Our study underlines the critical importance of well-preserved liver function for successful administration of sequential systemic therapy.