摘要：肝细胞癌（HCC）对东亚国家可造成很大的疾病负担。由巴塞罗那临床肝癌（BCLC）分期系统所定义的中期HCC对临床实践构成了的挑战，因为它包括的患者具有很大的异质性，因此在肿瘤负担，肝功能和疾病病原学方面都可以存在很大的差异。由于目标肿瘤无反应或肿瘤发生转移提示疾病进展，中期肝癌患者使用反复肝动脉栓塞化疗（TACE）治疗的临床预后常不甚理想。在2011年9月，肝细胞癌干预国际专家小组（EPOIHCC）在香港召开会议，并对TACE实践提供了临床共识。为此，专家小组浏览了目前整个亚洲的临床实践数据，包括单独使用TACE或联合其他靶向系统治疗的安全性及其疗效。这个述评概括了在会议上讨论的相关证据，并根据目前可用的治疗选择对于不可切除的中期肝癌提出了专家建议。专家小组的一个重要共识是，为了改善患者的预后和长期生存，应系统评价TACE联合全身靶向药物治疗的可能性。尽管目前可用的临床数据显示这种治疗方案是可行的，目前正在进行的几个关键的II期和III期随机对照试验的即将完成，这将为合理使用联合治疗方案提供进一步的证据。
文章来源：Liver International
原文地址：http://onlinelibrary.wiley.com/doi/10.1111/liv.12083/abstract
原文：
Title: Consensus recommendations and review by an International Expert Panel on Interventions in Hepatocellular Carcinoma (EPOIHCC)
Authors: Joong-Won Park, Deepak Amarapurkar, Yee Chao, et al
Abstract:
Hepatocellular carcinoma (HCC) presents with a high burden of disease in East Asian countries. Intermediate-stage HCC as defined by the Barcelona Clinic Liver Cancer (BCLC) staging system poses a clinical challenge as it includes a heterogeneous population of patients that can vary widely in terms of tumour burden, liver function and disease aetiology. Intermediate HCC patients often have unsatisfactory clinical outcomes with repeated transarterial chemoembolization (TACE, due to non-response of the target tumour or the development of further metastasis indicating progressive disease. In September 2011, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was convened in HK in an attempt to provide a consensus on the practice of TACE. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies. This review summarises the evidence discussed at the meeting and provides expert recommendation regarding the available therapeutic options for unresectable intermediate stage HCC. A key consensus of the Expert Panel was that in order to improve patient outcomes and long-term survival, the possibility of using TACE in combination with targeted agents given systemically should be explored. While the currently available clinical data is promising, the expected completion of several pivotal phase II and III RCTs will provide further evidence in support of the rationale for combination therapy regimens.
Journal: Liver International
Published: March 2013
文章来源：Liver International
原文地址：http://onlinelibrary.wiley.com/doi/10.1111/liv.12083/abstract
原文：
Title: Consensus recommendations and review by an International Expert Panel on Interventions in Hepatocellular Carcinoma (EPOIHCC)
Authors: Joong-Won Park, Deepak Amarapurkar, Yee Chao, et al
Abstract:
Hepatocellular carcinoma (HCC) presents with a high burden of disease in East Asian countries. Intermediate-stage HCC as defined by the Barcelona Clinic Liver Cancer (BCLC) staging system poses a clinical challenge as it includes a heterogeneous population of patients that can vary widely in terms of tumour burden, liver function and disease aetiology. Intermediate HCC patients often have unsatisfactory clinical outcomes with repeated transarterial chemoembolization (TACE, due to non-response of the target tumour or the development of further metastasis indicating progressive disease. In September 2011, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was convened in HK in an attempt to provide a consensus on the practice of TACE. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies. This review summarises the evidence discussed at the meeting and provides expert recommendation regarding the available therapeutic options for unresectable intermediate stage HCC. A key consensus of the Expert Panel was that in order to improve patient outcomes and long-term survival, the possibility of using TACE in combination with targeted agents given systemically should be explored. While the currently available clinical data is promising, the expected completion of several pivotal phase II and III RCTs will provide further evidence in support of the rationale for combination therapy regimens.
Journal: Liver International
Published: March 2013
