不可切除肝内胆管癌的治疗方法研究进展

Research progress in the treatment of unresectable intrahepatic cholangiocarcinoma

肝内胆管癌(ICC)是肝脏内第2常见原发性肿瘤,根治性手术切除是目前治愈ICC的主要方式,但ICC起病隐匿,进展迅速,临床发现时很多已经失去根治性手术的机会。临床常使用吉西他滨联合顺铂等化疗方案治疗不可切除的ICC,但疗效常不理想。靶向治疗、免疫治疗等新疗法的出现为治疗不可切除的ICC带来了新的方向。通过对ICC肿瘤发生机制的研究,研究人员发现了治疗ICC的潜在靶点,针对EGFR、VEGF、FGFR2、HER2、IDH1/2、BRAF、NTRK、MEK1/2等靶点的临床药物试验均已取得良好进展;免疫检查点抑制剂的试验也表现出对ICC患者的良好疗效。联合使用上述疗法还能使部分患者实现肿瘤降期,获得手术机会。本文综述了近年不可切除的ICC的治疗方法研究进展,以期为ICC治疗提供新思路。

Intrahepatic cholangiocarcinoma(ICC)is the second most common primary tumor in the liver,and radical surgical resection is currently the main way to cure ICC.But ICC has an insidious onset,rapid progression,and many have lost the opportunity for radical surgery when clinically found.Chemotherapy regimens such as gemcitabine combined with cisplatin are often used clinically to treat unresectable ICC,but the efficacy is often not satisfactory.The emergence of new therapies such as targeted therapy and immunotherapy has brought a new direction for the treatment of unresectable ICC.Through the study of the mechanism of ICC tumorigenesis,researchers have discovered potential targets for the treatment of ICC,and clinical drug trials for targets such as EGFR,VEGF,FGFR2,HER2,IDH1/2,BRAF,NTRK,MEK1/2 and other targets have made good progress.Trials of immune checkpoint inhibitors have also shown good efficacy in patients with ICC.The combination of the above therapies can also enable some patients to achieve tumor reduction and obtain surgical opportunities.This article reviews the recent research progress of treatment for unresectable ICC,in order to provide new ideas for the treatment of ICC.