肝细胞癌的免疫疗法和移植
Parissa Tabrizian1, Maen Abdelrahim2, Myron Schwartz1
1Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, United States.
Journal of hepatology
|January 22, 2024
概括
免疫检查点抑制剂 (ICI) 在肝移植 (LT) 之前对晚期肝细胞癌 (HCC) 有希望. 仔细的患者选择和管理对于平衡ICI益处与LT风险和免疫抑制需求至关重要.
科学领域:
- 肝胆道手术 肝胆道手术
- 移植免疫学 移植免疫学
- 医学瘤学 医学瘤学
背景情况:
- 免疫检查点抑制剂 (ICI) 是晚期肝细胞癌 (HCC) 的首要治疗方法.
- 肝移植 (LT) 是不可切除的HCC的关键治疗方法,但移植后的免疫抑制与ICI治疗相冲突.
- 在LT候选物中使用新辅助性ICI在预测反应和管理风险方面存在挑战.
研究的目的:
- 探索使用免疫检查点抑制剂 (ICI) 对接受肝移植 (LT) 的肝细胞癌 (HCC) 患者的复杂性和潜在益处.
- 讨论在LT前和LT后的新辅助环境中利用ICI的挑战和考虑.
- 突出进一步研究和生物标志物的需要,以建立安全有效的免疫治疗方案,在经过LT的HCC患者.
主要方法:
- 专家意见和当前关于ICI在HCC患者中使用的文献的审查,这些患者被认为是或曾经接受过LT.
- 对新辅助和移植后ICI治疗的潜在益处,风险和管理策略的分析.
- 讨论患者选择标准,ICI的时间,以及对不良事件的监测,包括移植排斥.
主要成果:
- 新辅助性ICI治疗可能有利于选择LT候选人,但需要谨慎管理,以减轻严重排斥的风险.
- 肝脏特异性因素可能会降低排斥风险,这需要进一步调查LT前ICI使用情况.
- 通常避免使用LT后的ICI,但PD-L1表达可以作为安全生物标志物,并且可以考虑治疗耐火性HCC复发.
结论:
- 整合ICI与LT用于HCC管理是复杂的,需要仔细的患者选择和风险效益评估.
- 进一步的前性研究和强大的生物标志物对于在LT前后定义最佳,安全的免疫治疗策略至关重要.
- 活体捐赠者LT在管理ICI洗期方面提供了灵活性,可能改善安全性.
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