摘要
近年来,靶向和免疫单药及联合治疗晚期肝癌的临床研究为一线用药方案选择提供了丰富的疗效与安全性证据。然而,对于肝癌二线治疗方案的选择,目前各项临床指南尚无统一意见,原因在于现有循证医学证据局限于索拉非尼失败后的选择,而对于新的一线方案,如靶向免疫联合治疗肝癌耐药后的二线治疗方案,依然缺乏高证据等级的临床试验结论。本文回顾了目前临床试验研究结果,根据药物作用的不同机制,对靶向免疫一线治疗耐药后肝癌二线治疗方案的研究进行了归纳,并系统总结近年研究进展。对于一线靶免联合治疗耐药的肝癌患者,靶向联合治疗、免疫双抗治疗均有望提高疗效、改善生存,未来还需更多前瞻性临床研究数据,为靶免联合治疗耐药的肝癌患者提供有效、安全的治疗方案。
In recent years,clinical studies on targeted therapy and immunotherapy for advanced hepatocellular carcinoma used alone or in combination have provided abundant evidence on efficacy and safety for the selection of first-line therapies.However,no consensus has been reached on the selection of second-line therapies in various clinical guidelines for hepatocellular carcinoma,which is caused by the fact that existing evidence is limited to the options after failure of sorafenib and that there is still a lack of high-level evidence for new first-line therapies such as second-line therapies after resistance to targeted therapy and immunotherapy for hepatocellular carcinoma.This article reviews the results of current clinical trials and summarizes the studies on second-line therapies for hepatocellular carcinoma after resistance to first-line targeted therapy and immunotherapy for hepatocellular carcinoma based on the different mechanisms of action of drugs,as well as the research advances in recent years.For hepatocellular carcinoma patients with resistance to first-line targeted therapy and immunotherapy,targeted combination therapy and dual-immune therapy are expected to improve treatment outcome and survival,and more prospective clinical studies are needed in the future to provide effective and safe treatment regimens for hepatocellular carcinoma patients with resistance to targeted therapy and immunotherapy.
作者
张天奇
曹钰哲
左孟轩
顾仰葵
ZHANG Tianqi;CAO Yuzhe;ZUO Mengxuan;GU Yangkui(Department of Minimally Invasive Interventional Therapy,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;State Key Laboratory of Oncology in South China,Guangzhou 510060,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2024年第2期386-390,共5页
Journal of Clinical Hepatology
基金
广州市科技计划项目(2024A04J4245)
广东省自然科学面上项目(2020A1515011539)。
关键词
癌
肝细胞
药物疗法
抗药性
肿瘤
Carcinoma,Hepatocellular
Drug Therapy
Drug Resistance,Neoplasm
