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[SMC Monday GI conference 2016-7-18. Managment of HCC (staff lecture from Young Han Paik)]

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TACE +/- sorafenib¿¡ ´ëÇÑ SPACE ¿¬±¸¿¡¼­ sorafenib Ãß°¡°¡ time to vascular invasionÀ̳ª overall survival¿¡ º¯È­°¡ ¾ø¾ú½À´Ï´Ù. µû¶ó¼­ ÇöÀç guideline¿¡´Â TACE¿¡ sorafenibÀ» ´õÇÏ´Â °ÍÀº ÃßõµÇÁö ¾Ê°í ÀÖ½À´Ï´Ù.

TACE +/- brivanib¿¡ ´ëÇÑ ¿¬±¸¿¡¼­µµ overall survival¿¡ º¯È­°¡ ¾ø¾ú½À´Ï´Ù. µû¶ó¼­ ÇöÀç guideline¿¡´Â TACE¿¡ brivanibÀ» ´õÇÏ´Â °ÍÀº ÃßõµÇÁö ¾Ê°í ÀÖ½À´Ï´Ù.

BRIDGE study. ¼­¾ç°ú µ¿¾ç¿¡¼­ guideline applicationÀÇ º¯È­¸¦ ºñ±³ÇÑ ¿¬±¸ÀÔ´Ï´Ù. ¼­¾ç°ú µ¿¾çÀÇ Ä¡·á¹æ¹ýÀÌ »ó´çÈ÷ ´Ù¸¨´Ï´Ù. ƯÈ÷ °¡À̵å¶óÀο¡¼­ TACE¸¦ ±ÇÇÏ´Â stage B¿¡¼­ 20% ȯÀÚ°¡ ¼ö¼úÀ» ¹Þ°í ÀÖÀ¸¸ç, °¡À̵å¶óÀο¡¼­ sorafenibÀ» ±ÇÇÏ´Â stage C¿¡¼­ »ó´çÈ÷ ¸¹Àº ȯÀÚ°¡ ¼ö¼úÀ̳ª TACE¸¦ ¹Þ°í ÀÖ½À´Ï´Ù. ÀÓ»ó¿¡¼­´Â °¡À̵å¶óÀÎÀÇ Ãßõº¸´Ù Àû±ØÀûÀÎ Ä¡·á°¡ ÁøÇàµÇ°í ÀÖ½À´Ï´Ù. (½Åµ¿Çö ±³¼ö´Ô comment: ¼­¾ç¿¡¼­´Â °¡À̵å¶óÀÎÀ» evidence¸¦ Á¤¸®ÇÑ °ÍÀ¸·Î »ý°¢Çϱ⠶§¹®¿¡ clinical practice¸¦ °í·ÁÇÏÁö ¾Ê´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. µ¿¾ç¿¡¼­´Â °¡À̵å¶óÀÎÀ» ¸¸µé ¶§ evidence¿Í ÇÔ²² clinical practice¸¦ °í·ÁÇÕ´Ï´Ù. ÀÌ·¯ÇÑ °ßÇØÂ÷°¡ BRIDGEÀÇ °á°ú¿¡ ³ª¿Â °ÍÀ¸·Î »ý°¢µË´Ï´Ù.)

SHARP ¿¬±¸¿¡¼­ sorafenib±ºÀÇ survivalÀÌ 3°³¿ù Á¤µµ »ýÁ¸±â°£ÀÌ ¿¬ÀåµÇ¾ú½À´Ï´Ù. ±×·¯³ª hepatitis C group¿¡¼­ º¸´Ù È¿°ú°¡ ÁÁ¾Ò½À´Ï´Ù. Alcoholic cirrhosis¿¡¼­´Â È¿°ú°¡ ¸øÇß½À´Ï´Ù. HBV (+) °£¾Ï ȯÀÚ´Â HCV (+) °£¾Ï ȯÀÚº¸´Ù sorafenib È¿°ú°¡ ´úÇß½À´Ï´Ù.

ÇâÈÄ Àü¸Á

(1) ¸î °¡Áö molecular therapy°¡ phase III ¿¬±¸¸¦ ¸¶Ãưųª ÁøÇàÁßÀε¥ ´ëºÎºÐÀÌ failÇÏ¿´½À´Ï´Ù. ¿Ö ÀÌ·± °á°ú°¡ ³ª¿Ô´ÂÁö¸¦ º¸¿©ÁÖ´Â Èï¹Ì·Î¿î ½½¶óÀ̵åÀÔ´Ï´Ù. ±× Áß Çϳª°¡ phase II¿¡¼­ È¿°ú°¡ ¸íÈ®ÇÏÁö ¾Ê¾Ò´Âµ¥ phase III ¿¬±¸°¡ ÁøÇàµÇ¾ú´Ù´Â °ÍÀÔ´Ï´Ù. (½Åµ¿Çö ±³¼ö´Ô comment: SorafenibÀÌ ´ë¼º°øÀ̾ú±â¶§¹®¿¡ Á¦¾à»ç³ª ¿¬±¸ÀÚ°¡ ³Ê¹« ¼­µÑ·¶´ø °Í °°½À´Ï´Ù.)

RegorafenibÀÌ ³»³â¿¡ FDA Åë°úÇÒ °Í °°½À´Ï´Ù. Sorafenib failure ȯÀÚ¿¡¼­ »ç¿ëÇÒ ¼ö ÀÖÀ» °ÍÀ¸·Î ¿¹»óµË´Ï´Ù.

Biomarker-based treatment: RamucirumabÀº AFP°¡ ³ôÀº ȯÀÚ¿¡¼­´Â µµ¿òÀÌ µÇ¾ú½À´Ï´Ù.

© EndoTODAY Endoscopy Learning Center. Jun Haeng Lee. ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà.