| 特集名 | 進行肝細胞癌の治療戦略 | |
|---|---|---|
| 題名 | 進行肝細胞癌に対する肝動注化学療法の適応と成績 | |
| 発刊年月 | 2015年 07月 | |
| 著者 | 小尾 俊太郎 | 公益財団法人佐々木研究所付属杏雲堂病院消化器・肝臓内科 |
| 著者 | 佐藤 新平 | 公益財団法人佐々木研究所付属杏雲堂病院消化器・肝臓内科 |
| 著者 | 河井 敏宏 | 公益財団法人佐々木研究所付属杏雲堂病院消化器・肝臓内科 |
| 著者 | 佐藤 隆久 | 公益財団法人佐々木研究所付属杏雲堂病院消化器・肝臓内科 |
| 著者 | 杉本 貴史 | 公益財団法人佐々木研究所付属杏雲堂病院消化器・肝臓内科 |
| 著者 | 菅田 美保 | 公益財団法人佐々木研究所付属杏雲堂病院消化器・肝臓内科 |
| 【 要旨 】 | 肝動注化学療法は奏効すればきわめて長期の生存が期待できるため，本邦においては多発肝癌あるいは脈管浸潤を伴う進行肝細胞癌の標準的治療として位置づけられてきた．しかしながら，エビデンスレベルの高い臨床試験は存在せず，さらに治療を行った集団全体の生存率についても，survival benefitがあるかどうか不明である．それゆえ肝細胞癌に対する肝動注化学療法は予後を改善する可能性はあるが十分な科学的根拠がないとされている．今後，肝動注化学療法の有効性を証明していく努力が必要である．現在，標準治療であるソラフェニブに対する上乗せ効果を検討する，多施設共同Phase3試験（SILIUS）が行われている． | |
| Theme | Treatment Strategy for Advanced Hepatocellular Carcinoma | |
|---|---|---|
| Title | Hepatic Arterial Infusion Chemotherapy for Advanced Liver Cancer | |
| Author | Shuntaro Obi | Gastroenterology and Hepatorology, Kyoundo Hospital, Sasaki Institute |
| Author | Shinpei Sato | Gastroenterology and Hepatorology, Kyoundo Hospital, Sasaki Institute |
| Author | Toshihiro Kawai | Gastroenterology and Hepatorology, Kyoundo Hospital, Sasaki Institute |
| Author | Takahisa Sato | Gastroenterology and Hepatorology, Kyoundo Hospital, Sasaki Institute |
| Author | Takafumi Sugimoto | Gastroenterology and Hepatorology, Kyoundo Hospital, Sasaki Institute |
| Author | Miho Kanda | Gastroenterology and Hepatorology, Kyoundo Hospital, Sasaki Institute |
| [ Summary ] | Liver cancer is the sixth most common cancer worldwide in terms of numbers of cases but because of the very poor prognosis, the number of deaths is almost the same. It is therefore the third most common cause of death from cancer. The majority of these tumors develop in patients who have liver cirrhosis. The development of HCC has an effect on the natural history of liver disease. In spite of screening systems, some HCCs are detected at an advanced stage. An increasing variety of therapeutic options is available for patients with HCC. Many of these options have a survival benefit. However, the long term prognosis of HCC remains disappointing, because recurrence of HCC is frequently encountered, and portal venous invasion of HCC often develops. According to the treatment algorithm for HCC, patients with advanced disease are candidates for sorafenib. However, while sorafenib has been proven to be effective in randomized controlled trials (RCTs), its use has limitations due to severe adverse events. Several other therapies have been evaluated, including hepatic arterial infusion chemotherapy (HAIC). However, there is no RCT evidence that these therapies contribute to prolongation of survival, although marginal effects such as shrinkage of tumor size or decrease of tumor numbers have been observed in selected cases. Several RCTs have been planned to evaluate HAIC using sorafenib as a control. These trials will clarify some of the uncertainties of HAIC. |
|