肝细胞癌免疫治疗的现状与未来

Current Status and Future of Immunotherapy for Hepatocellular Carcinoma

肝细胞癌(HCC)是全球最常见的恶性肿瘤之一,尤其在中国。70%~80%患者确诊时已届晚期,只能接受姑息治疗。10年来Sorafenib一直是肝癌治疗的标准用药,而系统化疗方案FOLFOX4也已作为我国HCC的指南推荐。尽管如此,系统治疗的疗效不高、生存时间不长的局面仍有待突破。免疫检查点抑制剂在诸多实体瘤中的应用开启了系统治疗的新局面,而免疫检查点通路分子在病毒相关肝炎、肝硬化、肝癌的发生发展过程起到重要的作用,同时也是Sorafenib治疗HCC失败的耐药机制之一。2017年9月23日,美国食品药品管理局(FDA)基于Ⅰ/Ⅱ期临床研究结果批准了Nivolumab在HCC中的应用,这标志着HCC免疫治疗新时代的到来。

Hepatocellular carcinoma(HCC)is one of the most common malignant tumors in the world,especially in China.70%-80%of patients are diagnosed at advanced stage and can only receive palliative care.Sorafenib has been the standard drug for the treatment of HCC for 10 years,and FOLFOX4,a systematic chemotherapy regimen,has been recommended as a guideline for HCC in China.However,all approved systemic therapies still unsatisfied with limited objective response rates and poor overall survival.The application of immune checkpoint inhibitors in many solid tumors opens up a new prospect of systemic therapy.Immune checkpoint pathway molecules play an important role in the occurrence and development of viral hepatitis,liver cirrhosis and liver cancer,and are also one of the resistance mechanisms of Sorafenib in the treatment of failed HCC on September 23,2017,FDA approved the application of Nivolumab in HCC based on the results of phase I/II clinical study,marking the arrival of a new era of HCC immunotherapy.