医学
肝细胞癌
肝移植
免疫疗法
移植
米兰标准
肿瘤科
癌
全身疗法
临床试验
酪氨酸激酶抑制剂
内科学
重症监护医学
癌症
乳腺癌
作者
Nguyen H. Tran,Sergio Muñoz,Scott M. Thompson,Christopher L. Hallemeier,Jordi Bruix
出处
期刊:Hepatology
[Lippincott Williams & Wilkins]
日期:2022-07-30
卷期号:76 (4): 1203-1218
被引量:34
摘要
Hepatocellular carcinoma remains a global health challenge affecting close to 1 million cases yearly. Liver transplantation provides the best long-term outcomes for those meeting strict criteria. Efforts have been made to expand these criteria, whereas others have attempted downstaging approaches. Although locoregional approaches to downstaging are appealing and have demonstrated efficacy, limitations and challenges exists including poor imaging modality to assess response and appropriate endpoints along the process. Recent advances in systemic treatments including immune checkpoint inhibitors alone or in combination with tyrosine kinase inhibitors have prompted the discussion regarding their role for downstaging disease prior to transplantation. Here, we provide a review of prior locoregional approaches for downstaging, new systemic agents and their role for downstaging, and finally, key and critical considerations of the assessment, endpoints, and optimal designs in clinical trials to address this key question.
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