肝细胞癌移植免疫疗法:辅助疗法的下一个前沿。

IF 1.8 4区 医学 Q3 TRANSPLANTATION
Parissa Tabrizian, Marcus Zeitlhoefler, Ahmed Talaat Hassan, Rebecca Marino
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引用次数: 0

摘要

综述目的:肝细胞癌(HCC)肝移植的成功率越来越高,这促使人们不断寻求创新策略,以扩大合格患者的范围。免疫肿瘤学的最新进展使免疫检查点抑制剂(ICIs)成为关注的焦点。本综述概述了ICIs在HCC肝移植中的最新应用,探讨了新辅助和辅助方法,并探讨了安全性、患者选择和反应预测等方面的未决问题:ICIs 已从最后的治疗希望转变为治疗晚期 HCC 不可或缺的基石,不仅是降低患者移植分期的令人信服的选择,也是解决移植后疾病复发的替代策略,前景广阔。尽管免疫治疗药物不断改进,但其中涉及的复杂分子通路强调了在肝移植中整合免疫疗法的综合方法的必要性。摘要:最初人们担心ICIs作为肝移植的桥接疗法会出现移植物排斥反应,但通过使用适当的免疫抑制剂策略和足够的冲洗期,成功地解决了这一问题,并将排斥反应降至最低。肝移植后疾病复发仍是一个挑战,需要在有效治疗和保护移植物功能之间取得平衡。应重视临床试验,验证 ICIs 在肝移植中的风险效益比,指导选择合适的患者,并建立明确的管理路径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Immunotherapy for transplantation of hepatocellular carcinoma: the next frontier in adjunctive therapy.

Purpose of review: The increasing success of liver transplantation in hepatocellular carcinoma (HCC) drives an ever-evolving search for innovative strategies to broaden eligible patients' pools. Recent advances in immuno-oncology have turned the spotlight on immune checkpoint inhibitors (ICIs). This review offers an updated overview of ICIs in liver transplantation for HCC, exploring neoadjuvant and adjuvant approaches and addressing unanswered questions on safety, patients' selection, and response predictors.

Recent findings: ICIs have transitioned from being a last-chance therapeutic hope to becoming an integral cornerstone in the treatment of advanced HCC, holding great promise as a compelling option not only to downstage patients for transplantation but also as an alternative strategy in addressing posttransplantation disease recurrence. Despite ongoing refinements in immunotherapeutic agents, the complex molecular pathways involved emphasize the need for a comprehensive approach to integrate immunotherapy in liver transplantation.

Summary: Initial concerns about graft rejection, with ICIs as a bridging therapy to liver transplantation, were successfully addressed using adequate immunosuppressants strategies and minimized with a sufficient washout period. Post-liver transplantation disease recurrence remains challenging, requiring a balance between effective therapy and preserving graft function. Emphasis should be placed on clinical trials validating the risk-benefit ratio of ICIs for liver transplantation, guiding appropriate patients' selection, and establishing clear management pathways.

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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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