http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
- 中文 을 입력하시려면 zhongwen을 입력하시고 space를누르시면됩니다.
- 北京 을 입력하시려면 beijing을 입력하시고 space를 누르시면 됩니다.
RISS 인기검색어
- 검색키워드
- 저자 : Llovet, J.M. (검색결과 3 건)
- 무료
- 기관 내 무료
- 유료
-
Rescue Therapies for Transarterial Chemoembolization Failure and Clinical Outcomes in HCC
( Josep M. Llovet ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Liver cancer is the second cause of mortality from any type of cancer worldwide. Among 5 treatments accepted by guidelinesas being effective (surgical resection, liver transplantation, radiofrequency ablation, transcatheter arterial chemoembolization(TACE) and sorafenib), TACE represents the standard of care for patients defined as being at intermediate HCC stage accordingto BCLC staging system. The natural history of these patients -those with multinodular-liver only tumors, ECOG 0 and Child PughA-B class- was defined in several series of 1980-90. Median survival is expected of 16 month, without treatment. ConventionalTACE (cTACE) should be applied supraselectively with an emulsion for gelfoam doxorubicin followed by embolization agents.Alternatively DEBead leaded with chemotherapy has shown similar objective response, but there is a lack of long-term comparisonsbetween these two strategies. TACE is effective based upon 2 Randomized controlled studies comparing this treatmentversus suboptimal therapies or best supportive care. Afterwards a meta-analysis of 6 RCT confirmed survival advantages for patientstreated specifically with chemoembolization, as opposed to bland embolization that has not showed survival advantages.As a result of these studies, TACE is the standard of care for intermediate HCC, and generally is applied a median of 3-4 timesper patient. Survival advantages in this setting of trials showed benefits of 4 months (from 16 to 20 months), but more recenttrials have reported median survival of around 26-30 months. Ideal candidates are patients with ECOG 0, multinodular unresectabletumors (generally sized below 10cm), no macrovascular invasion or extrahepatic spread. In terms of liver function,ideally patients should belong to Child-Pugh A class or B7 without ascites. Hepato-fugal blood flow is considered a formalcontraindication.During the past 10 years a controversy has emerged on how to manage patients with TACE, when to stop the treatment, andwhen to switch to other effective therapies. In general, achievement of objective response after 2 TACE is considered the bestindicator of improvement in survival. Although this has been the ideal scenario for TACE, some centers and even guidelines havepromoted treatment beyond progression as long as reamins intrahepatic. In fact, TACE is the most applied treatment in Asia,for both intermediate and advanced stages, despite the fact that it has not shown benefits in patients with macrovascular invasionof treatment-related symptoms. Therefore, other therapies should be considered once TACE have exhausted the capacity ofexpanding live expectancy, which should be considered after 2-3 treatments if a measurable response is not in place. In thesecases, the natural treatment for TACE failures is sorafenib. Sorafenib was shown effective in the subgroup analysis of SHARPfor in intermediate HCC, where this kinase inhibitor expanded survival from 11 to 14 months. This is consistent with the conceptof treatment stage migration described in EASL guidelines, where a given treatment should be considered for earlier stages ofthe disease in case that effective treatment for those sages already failed.Other therapies compete with sorafenib. This is the case of radioembolization with Y90. This therapy requires high-level equipmentin tertiary centers. So far, phase II data in centers of excellence have reported acceptable survival rates for Y90, but trialscomparing head-to-head with TACE failed recruitment. Conversely, there are currently several trials challenging sorafenib withY90, and the final phase III results are expected in the following months. The best survival results with Y90 have been reportedin patients with portal vein invasion, where mean survival of around 9 months was achieved in cohort studies. Phase III trialsconfirming these results are awaited. Other alternatives to sorafenib are molecular targeted therapies and immunotherapies.Regorafenib has been reported to be effective in patients progressing to sorafenib, in the setting of a phase III RESORCE trialin second line. Full information of this study will be available in short. Finally, immunotherapy, particularly with checkpoint inhibitors- such as nivolumab- have been reported to achieve objective response of 16% and median survival of 14 month insingle arm large studies.
-
-
연관 검색어 추천
이 검색어로 많이 본 자료
활용도 높은 자료
