Downstaging conversion therapy for advanced primary liver cancer
-
摘要:
中国大多数原发性肝癌患者初诊时已是中晚期,丧失手术治疗机会,因此,如何将中晚期肝癌降期为可手术切除的肝癌是近年临床研究热点。而能否转化成功的关键前提是,通过充分的检查评估和必要的多学科诊疗讨论筛选出适合转化的人群或可能转化成功的人群。分别介绍了因肺转移、门静脉癌栓、巨块型肿瘤播散或多发肿瘤的肝癌,肝功能失代偿的肝癌,已发生肝癌播散转移且ECOG体质评分> 2的肝癌以及HBV高载量肝癌的转化策略与转化后的抗肿瘤治疗策略,对临床中晚期肝癌患者的降期转化治疗具有一定的指导意义。
Abstract:Most patients with primary liver cancer in China are in the advanced stage at initial diagnosis and lose the opportunity for surgical treatment,and therefore,how to reduce advanced liver cancer to resectable liver cancer is a hot topic in clinical research in recent years.The key premise of successful conversion is to screen out the individuals who are suitable for conversion or may achieve successful conversion through comprehensive examination and necessary multidisciplinary consultation. This article introduces the conversion strategy and the antitumor strategy for liver cancer with lung metastasis,portal vein tumor thrombus,massive tumor dissemination,or multiple tumors,liver cancer with liver function decompensation,liver cancer with liver cancer dissemination and metastasis and an ECOG constitution score of >2,and liver cancer with a high HBV load,which has certain guiding significance in the downstaging conversion therapy for advanced liver cancer in clinical practice.
-
Key words:
- liver neoplasms /
- conversion therapy /
- multi-disciplinary treatment
-
[1] CHENG AL,KANG YK,CHEN Z,et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma:A phase III randomised,doubleblind,placebo-controlled trial[J]. Lancet Oncol,2009,10(1):25-34. [2] CURTIT E,THIERY-VUILLEMIN A,NGUYEN T,et al. Complete histologic response induced by sorafenib in advanced hepatocellular carcinoma:A case report[J]. J Clin Oncol,2011,29(12):e330-e332. [3] IRTAN S,CHOPIN-LALY X,RONOT M,et al. Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection[J]. Liver Int,2011,31(5):740-743. [4] BARBIER L,MUSCARI F,LE GUELLEC S,et al. Liver resection after downstaging hepatocellular carcinoma with sorafenib[J]. Int J Hepatol,2011,2011:791013. [5] WILLIET N,DUBREUIL O,BOUSSAHA T,et al. Neoadjuvant sorafenib combined with gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma[J]. World J Gastroenterol,2011,17(17):2255-2258. [6] DEGUCHI S,TSUKAMOTO T,KANAZAWA A,et al. A case of multiple HCC with Vp2 and Vp3 invasion controlled by multidisciplinary treatment including surgery[J]. Cancer Chemother,2015,42(12):1845-1847. [7] IKEDA M,OKUSAKA T,MITSUNAGA S,et al. Safety and pharmacokinetics of lenvatinib in patients with advanced hepatocellular carcinoma[J]. Clin Cancer Res,2016,22(6):1385-1394. [8] EL-KHOUEIRY AB,SANGRO B,YAU T,et al. Nivolumab in patients with advanced hepatocellular carcinoma(CheckMate040):An open-label,non-comparative,phase 1/2 dose escalation and expansion trial[J]. Lancet, 2017, 389(10088):2492-2502. [9] ZHU AX,FINN RS,EDELINE J,et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib(KEYNOTE-224):A non-randomised,open-label phase 2 trial[J]. Lancet Oncol,2018,19(7):940-952. [10] QIN S,BAI Y,LIM HY,et al. Randomized,multicenter,open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia[J]. J Clin Oncol,2013,31(28):3501-3508. [11] Chinese Society of Radiation Oncology,Chinese Medical Association; Liver Cancer Study Group and Expert Committee on Digestive System Neoplasms,Precise Radiotherapy Branch,Chinese Society of Biomedical Engineering; Liver Cancer Study Group,Radiation Oncology Branch,Chinese Research Hospital Association. Consensus on radiation therapy for primary liver cancer in 2016[J]. Chin J Radiat Oncol,2016,25(11):1141-1150.(in Chinese)中华医学会放射肿瘤学分会,中国生物医学工程学会精确放疗分会肝癌学组与消化系统肿瘤专家委员会,中国研究型医院学会放射肿瘤学分会肝癌学组.2016年原发性肝癌放疗共识[J].中华放射肿瘤学杂志,2016,25(11):1141-1150. [12] ZENG ZC,TANG ZY,FAN J,et al. A comparison of treatment combinations with and without radiotherapy for the hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus[J]. Oncol Progr,2006,4(4):284-307.(in Chinese)曾昭冲,汤钊猷,樊嘉,等.肝细胞肝癌伴门静脉/下腔静脉癌栓接受与不接受放射治疗的比较[J].癌症进展,2006,4(4):284-307. [13] KUDO M. Immuno-oncology in hepatocellular carcinoma:2017 update[J]. Oncology,2017,93(Suppl 1):147-159. [14] IKEDA M,SUNG MW,KUDO M,et al. A phase Ib trial of lenvatinib(LEN)plus pembrolizumab(PEMBRO)in unresectable hepatocellular carcinoma(u HCC):Updated results[C].2019 ESMO poster 747P,2019. [15] KEENAN B,GRIFFITH MJ,BAUER K,et al. Phase II multicenter pilot study of safety,efficacy,and immune cell profiling in advanced hepatocellular carcinoma(HCC)on combination of sorafenib(SOR)plus nivolumab(NIVO)[J]. J Clin Oncol,2019,37(4 Suppl):TPS464. [16] SPENCER KR,RAMSINGH G,MOHAMED N,et al. Phase Ib trial of cabozantinib(C)in combination with atezolizumab(A)in patients(pts)with advanced hepatocellular carcinoma(HCC),gastric or gastroesophageal junction cancer(GC/GEJC),or colorectal cancer(CRC)[J]. J Clin Oncol,2019,37(4 Suppl):TPS478. [17] LIU GY,LIU Y,ZHANG YW. TACE combined with sorafenib in the treatment of advanced HCC preliminary evaluation of the efficacy and safety[J/CD]. Electr J Liver Tumor,2018,5(2):19-23.(in Chinese)刘广宇,刘影,张跃伟.TACE联合索拉非尼治疗中晚期肝细胞肝癌疗效及安全性初步评价[J/CD].肝癌电子杂志,2018,5(2):19-23. [18] ZHANG YF,WEI W,WANG JH,et al. Transarterial chemoembolization combined with sorafenib for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus[J]. Onco Targets Ther,2016,9:4239-4246. [19] CHAO Y,CHUNG YH,HAN G,et al. The combination of transcatheter arterial chemoembolization and sorafenib is well tolerated and effective in Asian patients with hepatocellular carcinoma:final results of the START trial[J]. Int J Cancer,2015,136:1458-1467. [20] MENG MB,CUI YL,LU Y,et al. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma:A systematic review and metaanalysis[J]. Radiother Oncol,2009,92(2):184-194. [21] SEONG J,LEE IJ,SHIM SJ,et al. A multicenter retrospective cohort study of practice and clinical outcome on radiotherapy for hepatocellular carcinoma in Korea[J]. Liver Int,2009,29(2):147-152. [22] HSU HC,CHEN TY,CHIU KW,et al. Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma[J]. Br J Radiol,2007,80(949):38-42. [23] KUDO M. Locoregional therapy for hepatocellular carcinoma[J]. Liver Cancer,2015,4(3):163-164. [24] KUDO M. Surveillance,diagnosis,treatment,and outcome of liver cancer in Japan[J]. Liver Cancer,2015,4(1):39-50. [25] TSURUSAKI M,MURAKAMI T. Surgical and locoregional therapy of HCC:TACE[J]. Liver Cancer,2015,4(3):165-175. [26] ARIZUMI T,UESHIMA K,MINAMI T,et al. Effectiveness of sorafenib in patients with transcatheter arterial chemoembolization(TACE)refractory and intermediate-stage hepatocellular carcinoma[J]. Liver Cancer,2015,4(4):253-262. [27] TENG W,LIU KW,LIN CC,et al. Insufficient ablative margin determined by early computed tomography may predict the recurrence of hepatocellular carcinoma after radiofrequency ablation[J]. Liver Cancer,2015,4(1):26-38. [28] KANG TW,RHIM H. Recent advances in tumor ablation for hepatocellular carcinoma[J]. Liver Cancer,2015,4(3):176-187. [29] LENCIONI R,de BAERE T,MARTIN RC,et al. Imageguided ablation of malignant liver tumors:Recommendations for clinical validation of novel thermal and non-thermal technologies-a Western perspective[J]. Liver Cancer,2015,4(4):208-214. [30] KUDO M. Immune checkpoint inhibition in hepatocellular carcinoma:Basics and ongoing clinical trials[J]. Oncology,2017,92(Suppl 1):50-62. [31] MIZUKOSHI E,YAMASHITA T,ARAI K,et al. Enhancement of tumor-associated antigen-specific T cell responses by radiofrequency ablation of hepatocellular carcinoma[J]. Hepatology,2013,57(4):1448-1457. [32] LEE IJ,KIM JW,HAN KH,et al. Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma[J]. Yonsei Med J,2014,55(6):1489-1497. [33] CHEN SW,LIN LC,KUO YC,et al. Phase 2 study of combined sorafenib and radiation therapy in patients with advanced hepatocellular carcinoma[J]. Int J Radiat Oncol Biol Phys,2014,88(5):1041-1047. [34] KIM JH,PARK JW,KIM TH,et al. Hepatitis B virus reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepatocellular carcinoma[J].Int J Radiat Oncol Biol Phys,2007,69(3):813-819. [35] QIN SK,DONG JH,LU SC,et al. Clinical registry of primary liver cancer in China:A preliminary report[C]. The 20th National Congress of Clinical Oncology&The 2017 Annual Meeting of Chinese Society of Clinical Oncology. Xiamen,2017.(in Chinese)秦叔逵,董家鸿,卢实春,等.《中国原发性肝癌临床登记调查初步报告》[C].第二十届全国临床肿瘤学大会暨2017年CSCO学术年会.厦门,2017. [36] KUDO M,MATILLA A,SANTORO A,et al. Checkmate-040:Nivolumab(NIVO)in patients with advanced hepatocellular carcinoma and Child-Pugh B(CPB)status[J]. J Clin Oncol,2019,37(Suppl 4):327. [37] Expert Panel of Antiviral Therapy for Hepatocellular Carcinoma.Expert consensus on antiviral therapy to hepatitis B/C virusrelated hepatocellular carcinoma[J]. J Clin Hepatol,2014,30(5):390-395.(in Chinese)肝细胞癌抗病毒治疗专家组.HBV/HCV相关性肝细胞癌抗病毒治疗专家共识[J].临床肝胆病杂志,2014,30(5):390-395.
计量
- 文章访问数: 1650
- HTML全文浏览量: 74
- PDF下载量: 403
- 被引次数: 0