肝癌資訊

First-Line Therapy

Recommendation 1.1.

Atezolizumab-bevacizumab (atezo + bev) may be offered as first-line treatment for most patients with advanced HCC, Child-Pugh class A, ECOG PS 0-1, and following management of esophageal varices, when present, according to institutional guidelines.

Recommendation 1.2.

Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors (TKIs) sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC, Child-Pugh class A, and ECOG PS 0-1.

Second-Line Therapy

Recommendation 2.1.

Following first-line treatment with atezo + bev, second-line therapy with a TKI (ie, sorafenib, lenvatinib, cabozantinib, or regorafenib) may be recommended.

Recommendation 2.2.

Following first-line therapy with sorafenib or lenvatinib, second-line therapy with another TKI (cabozantinib or regorafenib), ramucirumab (AFP ≥ 400 ng/mL), or atezo + bev may be recommended for appropriate candidates. Considerations regarding choice of therapy are included in the Clinical Interpretation.

Recommendation 2.3.

Following first-line therapy with sorafenib or lenvatinib, pembrolizumab or nivolumab are reasonable options that may be considered for appropriate candidates.

第一線治療

建議 1.1.

對大部份晚期肝癌、初期肝硬化、ECOG PS 0-1 患者，可建議以 Atezolizumab-bevacizumab (atezo + bev) 為第一線治療，並遵循醫療院所食道靜脈曲張處理建議.

建議 1.2.

如因不適應症而無法使用 atezolizumab 或 bevacizumab, tyrosine kinase inhibitors (TKIs) sorafenib 或 lenvatinib 可建議為一線治療。

第二線治療

建議 2.1.

以 atezo + bev 一線治療後，二線治療可建議使用 TKI (ie, sorafenib, lenvatinib, cabozantinib, or regorafenib).

建議 2.2.

以 sorafenib 或 lenvatinib 為一線治療後，二線治療可使用其他 TKI (cabozantinib or regorafenib), ramucirumab (AFP ≥ 400 ng/mL), 或者 atezo + bev.

建議 2.3.

以 sorafenib 或 lenvatinib 為一線治療之後, 適合的病患也可以考慮使用 pembrolizumab 或 nivolumab 。

*台灣原廠藥物商品名稱對照 *

Atezolizumab = 癌自禦® Tecentriq®

Bevacizumab = 癌思停® Avastin®

Ramucirumab = 欣銳擇® Cyramza®

Pembrolizumab = 吉舒達® Keytruda®

Nivolumab = 保疾伏® Opdivo®

Sorafenib = 蕾莎瓦® Nexavar®

Lenvatinib = 樂衛瑪® Lenvima®

Cabozantinib = 癌必定® Cabometyx®

Regorafenib = 癌瑞格® Stivarga®