编者按：在2023年中国整合肿瘤学大会（CCHIO）的肿瘤肝脏病学国际分会场上，德国美因茨大学的Peter Galle教授带来了“当下和未来的肝细胞癌系统治疗 Current and future systemic treatment of hepatocellular carcinoma"的报告，会后肿瘤瞭望特邀Peter Galle教授就肝癌的系统治疗进展等话题进行专访。

Peter Galle教授：这是一次非常活跃的会议，进行了热烈的讨论，技术上非常合理，处理得很专业。因此，即使对于虚拟参会者来说，也很容易理解并参与讨论。我喜欢这样的设置，即提前安排准备充分的讨论者，能够在个人演讲中提出具体问题。总的来说，我们总结了肝细胞癌治疗的发展历程，为了提高的患者生存，目前这方面有很多新的进展。

Peter Galle: It was a very lively meeting with engaged discussions, and was technically very sound and professionally handled. So even for a virtual participant, it was easy to follow and get engaged in the discussion. I like the setting that there were predefined discussants who were well prepared and able to ask specific points in individual presentations. In general, we were summarizing the developments in hepatocellular carcinoma treatment, and for the benefit of our patients, there is a lot going on.

Peter Galle教授：最初我们几乎没有针对肝癌的全身治疗药物，我们最开始选择手术治疗，且对一些肝癌患者进行肝移植。介入放射学在一定程度上改变了肝癌的治疗模式，我们有了经动脉化疗栓塞术。直到 2007/2008 年，TKI抑制剂索拉非尼才进入舞台。刚开始它不太受欢迎，因为疗效有限，且耐受性也不是很好，但索拉非尼出现的区别在于它使肝癌变成了一种可经系统治疗治愈的疾病。后来我们看到其他TKI也进入了临床，一线治疗药物包括仑伐替尼和卡博替尼，瑞戈非尼和雷莫芦单抗可作为二线治疗。最显著的差异出现在 2020 年，阿替利珠单抗和贝伐珠单抗作为免疫治疗改变了肝癌的预后。今年增加了另一种免疫治疗干预措施——喜马拉雅方案，即度伐利尤单抗单抗联合曲美木单抗可作为另一种治疗选择。随着系统治疗不断取得成功，我们目前正在尝试将这些免疫联合方案应用到肝癌的早期、局部晚期和辅助治疗等阶段，目前确实有很多新的进展正在发生。

Peter Galle: We started basically with not being able to offer anything. Initially we were doing surgery and transplantation in some patients. Then interventional radiology changed the arena to some extent. There was transarterial chemoembolization. But it was not before 2007/2008 when the TKI, sorafenib, entered the stage. It was not so well received, because it was not extremely effective and not so well tolerated, but the difference between before and after sorafenib was that it is a treatable disease - it is a tumor where systemic therapy works. Then we saw other TKIs entering the stage -lenvatinib and cabozantinib in first-line therapy; and regorafenib and ramucirumab in second-line therapy. But the most dramatic difference as a game changer came in 2020 when atezolizumab and bevacizumab offered immunotherapy. This year, there is the addition of another immunotherapeutic intervention - the HIMALAYA protocol, durvalumab plus tremelimumab, as another option. The story goes on with these successes in systemic therapy. We are now switching to earlier stages, intermediate stage and adjuvant settings, and there is really a lot going on currently.

Peter Galle教授：从TKI单药治疗开始，到后来的免疫检查点抑制单药治疗，疗效都不是很令人满意，差异来自于双药治疗。阿替利珠单抗/贝伐珠单抗和度伐利尤单抗/tremelimumab 等双药联合药物正在发挥作用。现在我们正在对三药联合方案进行研究，还增加了其他靶点，如TIGIT和LAG3等。它们将是很有前景的方案，我乐观地认为，未来我们将看到三联疗法用于晚期肝癌的治疗。此外，我们也会看到适合早期肝癌的全身治疗。
Peter Galle：I see the development where we started with a monotherapy TKI, then monotherapy immune checkpoint inhibition, which was not so successful, and then the difference came from doublet therapy. Doublets such as atezolizumab/bevacizumab and durvalumab/tremelimumab are making the difference. Now we have investigations going on with triplets, adding other targets, such as TIGIT and LAG3. They will be promising approaches, and I am optimistic that in the future, we will see triple therapy in advanced stage disease. In addition, we will see systemic therapy in earlier stage disease.