肝细胞癌血管介入治疗联合靶向和免疫治疗进展

Progress of vascular intervention combined with targeted therapy and immunotherapy for hepatocellular carcinoma

以经导管动脉化疗栓塞(TACE)和肝动脉灌注化疗为代表的血管介入治疗是临床治疗不可切除中晚期肝细胞癌(HCC)的主要方式。其中,TACE贯穿于Ⅰb至Ⅲb期HCC的治疗。多靶点的酪氨酸激酶抑制剂及血管生成抑制剂等靶向药物在晚期肝癌的治疗和辅助治疗中发挥了重要作用,临床应用已相当成熟。近年来,以免疫检查点抑制剂为主导的免疫治疗逐渐成为临床研究和应用的新热点。HCC发病率高,多数患者初次就诊时已经处于中晚期。对于此类HCC患者的治疗而言,现有的经血管介入治疗、靶向治疗还是免疫治疗,单一治疗手段疗效并不尽如人意,这使得联合疗法在HCC治疗中的探索成为新趋势。

Vascular interventional therapy represented by transcatheter arterial chemoembolization(TACE)and hepatic artery infusion chemotherapy is the main clinical treatment of unresectable hepatocellular carcinoma(HCC).Among them,TACE was used throughout the treatment of stage Ib to IIIb HCC.Targeted drugs such as multi-target tyrosine kinase inhibitors and angiogenesis inhibitors have played an important role in the treatment and adjuvant therapy of advanced liver cancer,and their clinical application has been quite mature.In recent years,immunotherapy led by immune checkpoint inhibitors has gradually become the latest hot spot in clinical research and application.Patients with high rates of HCC,most often found for the first time has been in the middle-late stage.For the treatment of such patients with HCC,existing vascular intervention targeted therapy and immunotherapy,a single treatment curative effect is not very desirable,this makes the combination therapy in treating HCC has become a new trend.