乐伐替尼治疗晚期肝癌患者疗效的预测和预后因素研究进展

Predictive and prognostic factors in HCC patients treated with lenvatinib

索拉非尼和乐伐替尼是专家推荐的ⅠA级晚期系统性治疗肝癌的靶向药,两者均为酪氨酸激酶抑制剂类药。索拉非尼在我国治疗晚期肝癌已有10年之久,用药经验丰富。在SHARP试验中,索拉非尼总有效率为2.3%,REFLECT试验中索拉非尼组总有效率较低,仅为9.8%,且在大型临床试验中不良反应发生率均较高,在晚期肝癌治疗方面受限。乐伐替尼在我国上市2年余,用药经验尚且不足,但基于REFLECT试验中国亚组分析,其总体疗效是更优越的。就个体而言,由于其不良反应导致用药剂量减少或中断,从而使得疗效因患者情况不同而千差万别,因此预测晚期肝癌患者应用乐伐替尼效果的影响因素尤为重要,并且成为新的研究热点。本文探讨应用乐伐替尼治疗晚期肝癌效果的可能预测因素,以期优化选择乐伐替尼用药人群,提高乐伐替尼的疗效,并且指导用药经验。

Lenvatinib and sorafenib areⅠA recommended as first-line drugs for systemic treatment of advanced hepatocellular carcinoma,which of them are tyrosinase inhibitors.Sorafenib has been the only standard treatment of advanced liver cancer for 10 years in China.However,due to the overall objective response rate of SHARP trial,REFLECT trial was 2.3%,9.8%,respectively and the high incidence of adverse reactions,it is limited in the treatment of advanced hepatocellular carcinoma.Lenvatinib has been the first-line drug in China since 2018,and its experience is still insufficient.However,based on the Chinese subgroup analysis of REFLECT study(phaseⅢnon inferiority study),the superiority over sorafenib in objective response rate is confirmed.Due to individual difference,tumor heterogeneity,the dose reduction or discontinuation resulting from adverse reactions,the efficacy varies a lot.Therefore,it is particularly important to predict the efficacy of lenvatinib in patients with advanced liver cancer and has become a new research hotspot.This review discusses the possible predictive factors of the effect of lenvatinib in the treatment of advanced liver cancer,in order to optimize the suitable candidates,improve the efficacy of lenvatinib,and guide the clinical experience of lenvatinib.