提高肝癌转化治疗成功率的策略与挑战

Strategies and challenges in improving the success rate of conversion therapy for hepatocellular carcinoma

尽管根治性手术切除在肝癌治疗中效果显著,但仅约30%的病人有手术机会,而对于不可切除肝癌病人而言,预后仍不容乐观。近年来,包括免疫治疗在内的全身系统治疗方案在局部晚期肝癌的治疗中取得了重大进展。然而,这些治疗方案面临诸多挑战,包括难以确定最佳治疗周期和停止治疗的具体时间点,以及较高的治疗相关不良事件发生率。仅约10%的病人能够通过全身系统治疗实现完全缓解。外科治疗的目标是通过转化治疗方案,将不可切除的肝癌病人转化为可切除,从而显著改善病人的预后。2022年,START-FIT临床试验推出了一种新型的多模式、序贯式治疗方案,结合了经动脉化疗栓塞、立体定向放疗和免疫疗法。该方案的初步结果显示,约40%的病人达到了完全缓解,另有12%的病人成功转化为手术治疗。这一进展为不可切除肝癌病人带来了新的希望,并为未来的治疗策略提供了重要的参考。

Despite the effectiveness of surgical resection,only 30%of the patients are amenable to such curative treatment and the prognosis of unresectable liver cancer remains dismal.In recent years,significant advancements have been made in systemic therapies,including immunotherapy,for the treatment of locally advanced HCC.However,these treatment options face several challenges,including difficulties in determining the optimal duration of therapy,identifying the appropriate time to discontinue treatment,and managing the high incidence of treatment-related adverse events.Moreover,only about 10%of patients achieve complete response through systemic therapy alone.The goal of surgical treatment is to employ conversion therapy strategies to render unresectable HCC resectable,thereby significantly improving patient outcomes.In 2022,the START-FIT clinical trial introduced a novel multimodal,sequential treatment approach that combines transarterial chemoembolization(TACE),stereotactic body radiotherapy(SBRT),and immunotherapy.Preliminary results from this trial indicated that approximately 40%of patients achieved a complete response,with an additional 12%successfully converting to surgical candidates.This advancement offers new hope for patients with unresectable HCC and provides valuable insights for future treatment strategies.The integrated approach highlights the potential of the START-FIT regimen in enhancing therapeutic efficacy and expanding surgical opportunities,marking a significant breakthrough in the field of conversion therapy for HCC.