重视肝细胞癌靶向及免疫治疗的肝损伤  

Emphasis on targeted and immunotherapy for liver injury in hepatocellular carcinoma

作　　者：南月敏[1] 刘领弟[1] 赵素贤[1] Nan Yuemin;Liu Lingdi;Zhao Suxian(Department of Traditional and Western Medical Hepatology,Hebei Medical University Third Hospital,the Key Laboratory of Hepatic Fibrosis Mechanisms of Chronic Liver Diseases in Hebei Province,Hebei International Science and Technology Cooperation Base--Hebei International Joint Research Center for Molecular Diagnosis of Liver Cancer,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院中西医结合肝病科、河北省慢性肝病肝纤维化研究重点实验室、河北省国际科技合作基地--河北省肝癌分子诊断国际联合研究中心,石家庄050051

出　　处：《中华肝脏病杂志》2023年第11期1121-1124,共4页Chinese Journal of Hepatology

基　　金：河北省第四批高端人才基金;2021年政府资助临床医学人才培养项目。

摘　　要：肝细胞癌(HCC)分子靶向药物及免疫检查点抑制剂(ICIs)治疗已成为不可切除HCC一线治疗方案及根治性治疗高复发风险患者抗复发治疗的选择之一。一线分子靶向药物联合ICIs治疗或双免治疗的中位总生存期、客观缓解率均较单一靶向药物显著改善。HCC靶向及免疫治疗适用于Child-PughA~B级患者,靶向药物所致肝损伤包括转氨酶、胆红素异常,严重者可发生低蛋白血症、腹水等。ICIs相关性肝炎多发生于1~3个疗程(4~12周),其治疗可应用糖皮质激素,必要时加用吗替麦考酚酯等免疫抑制剂治疗,肝功能复常后可根据全身状况及肿瘤治疗需求选择不同作用机制靶向药物及ICIs治疗。Treatment with molecular targeted drugs and immune checkpoint inhibitors(ICIs)has become the first-line treatment options for unresectable HCC(hepatocellular carcinoma)and is also one of the anti-recurrence therapies of choice for patients at high risk of recurrence following radical treatment.First-line molecular targeted drugs combined with ICIs or dual-immune therapy significantly increase the median overall survival and objective response rate compared to single-targeted drugs.Targeted therapy and immunotherapy are suitable for HCC patients with Child-Pugh classes A~B.Liver damage caused by targeted drugs includes abnormal transaminases and bilirubin and,in severe cases,hypoproteinemia,ascites,and other occurrences.ICIs-associated immune-mediated hepatitis(IMH)mostly occurs within one to three sessions of treatment(4~12 weeks)and can be treated with glucocorticoids.However,immunosuppressants such as mycophenolate mofetil may be used as necessary.Targeted drugs and ICIs with different mechanisms of action can be selected based on the systemic condition and tumor treatment needs following the restoration of normal liver function.

关 键 词：肝细胞癌 酪氨酸激酶抑制剂 抗血管生成药物 免疫检查点抑制剂 肝损伤 

分 类 号：R735.7[医药卫生—肿瘤]