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Терапия гепатоцеллюлярного рака: реалии и перспективы

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В статье рассмотрены результаты клинических исследований и перспективы периоперационной системной терапии рака печени, а также эффективность сочетания с локорегионарными методами. Отдельное внимание уделено терапии гепатоцеллюлярного рака в 1-й и 2-й линии как уже одобренными в РФ препаратами (мультикиназные ингибиторы, моноклональные антитела крецептору фактора роста эндотелия сосудов, ингибиторы контрольных точек), так и идущим клиническим исследованиям. Рассмотрены перспективные комбинации иммунотерапии с мультикиназными и (или) ангиогенными ингибиторами, потенциальные предикторы эффективности иммунотерапии гепатоцеллюлярного рака, а также особенности терапии после ортотопической трансплантации печени и на фоне некомпенсированного цирроза печени.

Ключевые слова:
печень, гепатоцеллюлярный рак, системная терапия, локорегионарная терапия, сорафениб, ленватиниб, кабозантиниб, регорафениб, анти-PD1/PD-L1, liver, hepatocellular carcinoma, systemic therapy, locoregional therapy, sorafenib, lenvatinib, cabozantinib, regorafenib, anti-PD1/PD-L1

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Systemic therapy of hepatocellular carcinoma: reality and prospects

This article discusses the results of clinical trials and the perspectives for perioperative systemic therapy for liver cancer, as well as the effectiveness of combination with locoregional methods. Special attention is paid to first and second line hepatocellular carcinoma therapy, as already approved in the Russian Federation (multikinase inhibitors, monoclonal antibodies to the vascular endothelial growth factor receptor, checkpoint inhibitors), as well as ongoing clinical trials. Promising combinations of immunotherapy with multikinase and (or) angiogenic inhibitors, potential predictors of the effectiveness of immunotherapy for hepatocellular carcinoma, as well as the features of therapy after orthotopic liver transplantation and against the background of non-compensated liver cirrhosis, are considered.

Keywords:
печень, гепатоцеллюлярный рак, системная терапия, локорегионарная терапия, сорафениб, ленватиниб, кабозантиниб, регорафениб, анти-PD1/PD-L1, liver, hepatocellular carcinoma, systemic therapy, locoregional therapy, sorafenib, lenvatinib, cabozantinib, regorafenib, anti-PD1/PD-L1