肝动脉灌注化疗联合系统治疗在原发性肝癌中的研究进展

Research progress in hepatic arterial infusion chemotherapy combined with systemic therapy for the treatment of primary hepatocellular carcinoma

原发性肝癌是常见的恶性肿瘤之一,肝动脉灌注化疗(HAIC)和系统治疗是中晚期肝癌主要的治疗方式。HAIC通过方案及介入技术的改进,能够有效控制肝内病灶且安全性好。系统治疗从单一的靶向药物或免疫治疗进入靶免联合的时代,治疗手段日益丰富。但无论是HAIC或系统治疗,单一治疗效果有限。近年来,HAIC联合系统治疗能有效提高客观缓解率、延长无进展生存时间、增加转化切除机会。但对于长期生存获益、选择最优联合方案、筛选合适的目标人群等问题的解决仍需积累临床经验。当前证据表明,HAIC联合索拉非尼对于肝癌合并门静脉主干癌栓疗效确切,联合仑伐替尼或免疫治疗仍需探索,联合免疫及靶向治疗是未来一线治疗的潜在选择。

Primary hepatocellular carcinoma(HCC)is one of the common malignant tumors.Hepatic artery infusion chemotherapy(HAIC)and systemic therapy are important treatment options for medium-advanced HCC.With the improvement of chemotherapy scheme and interventional technology,HAIC has been able to effectively control the intrahepatic lesions with good safety.Systemic therapy,which originally adopted single targeted drug or immunotherapy,has already entered a new era characterized by targeted therapy combined with immunotherapy,and the treatment methods are becoming more and more.But,the efficacy of single therapy,regardless of HAIC therapy or systematic therapy,is limited.In recent years,HAIC combined with systemic therapy has achieved certain effectiveness in improving objective remission rate,prolonging progression-free survival,and increasing the opportunity of transformation resection.However,more clinical experience needs to be accumulated before some important issues such as the long-term survival benefits,the selection of optimal combination scheme,the screening of suitable target population,etc.can be solved.Current evidences show that HAIC combined with sorafenib carries reliable effect for HCC complicated by main portal vein tumor thrombus,but HAIC combined with lenvatinib or immunotherapy still needs to be further studied.HAIC combined with immunotherapy and targeted therapy is a potential option for future first-line therapy.