直接抗病毒药物与肝细胞癌临床研究新进展

Clinical research on direct antiviral drugs and hepatocellular carcinoma

丙型肝炎病毒(hepatitis C virus,HCV)感染是肝细胞癌(hepatocellular carcinoma,HCC)发生的重要原因之一。在过去的几十年中,基于干扰素的抗病毒治疗已被广泛接受。干扰素可通过实现持续病毒学应答(sustained virological response,SVR)而降低HCV相关肝硬化患者HCC的发生率及复发率,然而较低的持续病毒学应答率则限制了其进一步应用。近年来,随着直接抗病毒药物(direct antiviral agent,DAA)的应用,治疗方案已经发生了改变,DAA治疗可将HCV治疗的SVR率提高至95%以上。但基于DAA的无干扰素方案对HCC发生率及复发率的影响却仍存在争议。最初有研究报道了DAA治疗后的HCC高发生率和高复发率,而更近的研究则提供了大量证据对此进行驳斥。然而在获得更多中长期数据前,关于DAA治疗对于HCC发生率的影响尚无定论。本文现对DAA与HCC临床研究新进展进行综述。

Hepatitis C virus(HCV)infection is one of the major causes of hepatocellular carcinoma(HCC).In recent decades,interferon(IFN)based regimens has been accepted by the public.This kind of anti-HCV therapy will decrease the occurrence and recurrence risks of HCV related HCC by achieving sustained virological response(SVR).However,the low SVR rate limits its extension.In the last couple of years,this situation has been changed by the introduction of direct antiviral agent(DAA).These drugs increase the SVR rate to higher than 95%.However,the effect of DAA-based interferon-free regimens on incidence and recurrence rate of HCC remains controversial.Some initial reports were in favor of an increased risk of HCC occurrence and recurrence after DAA therapies.Contrarily,recent reports provided plenty of evidence against it.The impact of DAA therapy on HCC risk will be inconclusive until more long-term and intermediate data become available.The clinical research on DAA and HCC were reviewed in this paper.