肝癌的免疫治疗:有希望便是光明

Immunotherapy for hepacellular carcinoma:where there is hope,there is brightness

全世界近一半的肝癌发生在我国, 靶向治疗和全身化疗治疗肝癌的疗效有限, 以免疫检查点抑制剂为核心的治疗策略为患者带来新的希望。特别是免疫检查点抑制剂联合抗血管生成药物一线治疗肝癌的成功, 开启了肝癌的免疫联合治疗模式, 包括联合靶向、化疗、放疗、溶瘤病毒以及另一种免疫治疗等多种策略。然而, 原发性和继发性耐药极大地限制了免疫单药及免疫联合治疗的临床疗效。笔者阐述肝癌免疫治疗的相关热点、难点问题, 提出未来潜在的努力方向:鉴定有效的疗效预测标志物, 精准定位受益个体并避免不必要的药物不良反应;加强多学科高度一体化的患者全程管理;重视肿瘤免疫应答的机制研究, 针对性研发药物及开发新的综合治疗策略;为实现肝癌在"健康中国2030"规划纲要中的目标和任务而不懈努力。

China has about half of hepatocellular carcinoma(HCC)patients worldwide,and the efficay of targeted therapy and systematic chemotherapy for HCC is limited.The treatment stategies based on immune checkpoint inhibitors(ICIs)bring hope to patients.Especially,the success of ICIs plus anti-angiogenic drugs as the first-line treatment in HCC open the combinational immunotherapy model for HCC,which inludes targeted therapy,chemotherapy,radiotherapy,oncolytic virotherapy and another immunotherapy.However,most patients do not derive benefits from these agents or combinational treatments,due to innate and acquired immune resistance.The authors elaborate on hot and difficult subjects of immunotherapy for HCC,and formulate the potential striving direction.It is critical to understand the determinants driving response,resistance and adverse effects to optimize the implementation of precision immunotherapy.Overall manage-ment of HCC patients with multidesciplinary team and high integration should be strengthened.More effective immunotherapeutic strategies may be achieved though deeper understanding of the underlying immune biology,targeted drug development and new comprehensive strategies.All the above efforts are for aims and missions of"Healthy China 2030".