Иммунотерапия гепатоцеллюлярной карциномы у пациентов, перенёсших пересадку печени (обзор литературы)

Гепатоцеллюлярная карцинома (ГЦК) - третья причина смертности от рака во всем мире, на которую приходится более 800 000 смертей ежегодно. Хирургическое удаление новообразования остаётся наиболее эффективным вариантом лечения. Частичная резекция печени является адекватным решением для пациентов без цирроза или с хорошо компенсированным циррозом, ортотопическая трансплантация печени необходима у пациентов с ранней стадией ГЦК на фоне цирроза. Рецидив опухоли остаётся основным ограничением долгосрочной выживаемости пациентов после трансплантации печени. Посттрансплантационная иммуносупрессия снижает противоопухолевую защиту организма, которая обеспечивается естественным иммунитетом. Это способствует развитию и прогрессированию опухолевого процесса. Цель исследования: проанализировать отечественные и зарубежные публикации, в которых представлены варианты лечения рецидива ГЦК после трансплантации печени. Проведён поиск литературных источников в базах данных PubMed, Scopus, Web of Science, MEDLINE, eLibrary. Поиск проводили на русском и английском языках, по ключевым словам: гепатоцеллюлярная карцинома, ингибиторы терозинкиназы, ингибиторы иммунных контрольных точек, терапия рецидива ГЦК, ортотопическая трансплантация печени, индекс RETREAT, регорафениб, ниволумаб. Авторами представлен обзор данных о применении ингибиторов терозинкиназы и ингибиторов иммунных контрольных точек для предотвращения рецидива ГЦК. Результаты анализа источников литературы показали, что вопрос посттрансплантационной иммуносупрессии является актуальным. Большое количество исследований и разборов клинических случаев оставляет надежду, что в скором времени будет найден эффективный способ проведения иммуносупрессии для рецидивирующих пациентов с ГЦК после пересадки печени.

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