Trial eligibility in advanced hepatocellular carcinoma: Does it support clinical practice in underrepresented subgroups?  

作　　者：Federico Piñero Leonardo Gomes da Fonseca 

机构地区：[1]Hepatology and Liver Unit,Hospital Universitario Austral,School of Medicine,Austral University,Buenos Aires B1629HJ,Argentina [2]Clinical Oncology,Insituto do Cancer do Estado de São Paulo,University of São Paulo,São Paulo 05403-000,Brazil

出　　处：《World Journal of Gastroenterology》2021年第24期3429-3439,共11页世界胃肠病学杂志（英文版）

摘　　要：Although hepatocellular carcinoma is considered a highly lethal malignancy,recent therapeutic advances have been achieved during the last 10 years.This scenario resulted in an unprecedented improvement in survival for patients with advanced hepatocellular carcinoma,almost reaching 20-26 mo of overall survival after first-second line sequential treatment.The advent of the combination of atezolizumab with bevacizumab showed,for the first time,superiority over sorafenib with improvement in overall survival.However,first and second-line trials were correctly based on the premise that a strict selection of patients enhances the power to capture the positive effect of treatment by excluding competing risks for mortality such as liver failure,decompensated cirrhosis or other underlying medical conditions.As a result,the inclusion criteria used in clinical trials do not support the use of novel therapies in several real-world scenarios involving underrepresented subgroups,such as patients with unpreserved liver function,other comorbid conditions,a history of solid-organ transplantation,autoimmune disorders and those with a high risk of bleeding.The present text aims at discussing treatment strategies in these subgroups.

关 键 词：ELIGIBILITY Systemic therapies END-STAGE Hepatocellular carcinoma 

分 类 号：R73[医药卫生—肿瘤]