关键词: 肝细胞癌, 转化治疗, 靶向治疗, 免疫治疗, 三联序贯式转化治疗

Abstract: Despite the effectiveness of surgical resection, only 30% of the patients are amenable to such curative treatment and the prognosis of unresectable liver cancer remains dismal. In recent years, significant advancements have been made in systemic therapies, including immunotherapy, for the treatment of locally advanced HCC. However, these treatment options face several challenges, including difficulties in determining the optimal duration of therapy, identifying the appropriate time to discontinue treatment, and managing the high incidence of treatment-related adverse events. Moreover, only about 10% of patients achieve complete response through systemic therapy alone. The goal of surgical treatment is to employ conversion therapy strategies to render unresectable HCC resectable, thereby significantly improving patient outcomes. In 2022, the START-FIT clinical trial introduced a novel multimodal, sequential treatment approach that combines transarterial chemoembolization (TACE), stereotactic body radiotherapy (SBRT), and immunotherapy. Preliminary results from this trial indicated that approximately 40% of patients achieved a complete response, with an additional 12% successfully converting to surgical candidates. This advancement offers new hope for patients with unresectable HCC and provides valuable insights for future treatment strategies. The integrated approach highlights the potential of the START-FIT regimen in enhancing therapeutic efficacy and expanding surgical opportunities, marking a significant breakthrough in the field of conversion therapy for HCC.

Key words: hepatocellular carcinoma, conversion therapy, targeted therapy, immunotherapy, START-FIT