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De Stefano N, Patrono D, Colli F, Rizza G, Paraluppi G, Romagnoli R. Liver Transplantation for Hepatocellular Carcinoma in the Era of Immune Checkpoint Inhibitors. Cancers (Basel) 2024; 16:2374. [PMID: 39001436 PMCID: PMC11240403 DOI: 10.3390/cancers16132374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Hepatocellular carcinoma (HCC) remains the leading oncological indication for liver transplantation (LT), with evolving and broadened inclusion criteria. Immune checkpoint inhibitors (ICIs) gained a central role in systemic HCC treatment and showed potential in the peri-transplant setting as downstaging/bridging therapy before LT or as a treatment for HCC recurrence following LT. However, the antagonistic mechanisms of action between ICIs and immunosuppressive drugs pose significant challenges, particularly regarding the risk of acute rejection (AR). This review analyzes the main signaling pathways targeted by ICI therapies and summarizes current studies on ICI therapy before and after LT. The literature on this topic is limited and highly heterogeneous, precluding definitive evidence-based conclusions. The use of ICIs before LT appears promising, provided that a sufficient wash-out period is implemented. In contrast, the results of post-LT ICI therapy do not support its wide clinical application due to high AR rates and overall poor response to treatment. In the future, modern graft preservation techniques might support the selection of good ICI responders, but data from high-level studies are urgently needed.
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Affiliation(s)
| | | | | | | | | | - Renato Romagnoli
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Torino, Corso Bramante 88-90, 10126 Torino, Italy; (N.D.S.); (D.P.); (F.C.); (G.R.); (G.P.)
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Zhou XQ, Li YP, Dang SS. Precision targeting in hepatocellular carcinoma: Exploring ligand-receptor mediated nanotherapy. World J Hepatol 2024; 16:164-176. [PMID: 38495282 PMCID: PMC10941735 DOI: 10.4254/wjh.v16.i2.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 02/27/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and poses a major challenge to global health due to its high morbidity and mortality. Conventional chemotherapy is usually targeted to patients with intermediate to advanced stages, but it is often ineffective and suffers from problems such as multidrug resistance, rapid drug clearance, nonspecific targeting, high side effects, and low drug accumulation in tumor cells. In response to these limitations, recent advances in nanoparticle-mediated targeted drug delivery technologies have emerged as breakthrough approaches for the treatment of HCC. This review focuses on recent advances in nanoparticle-based targeted drug delivery systems, with special attention to various receptors overexpressed on HCC cells. These receptors are key to enhancing the specificity and efficacy of nanoparticle delivery and represent a new paradigm for actively targeting and combating HCC. We comprehensively summarize the current understanding of these receptors, their role in nanoparticle targeting, and the impact of such targeted therapies on HCC. By gaining a deeper understanding of the receptor-mediated mechanisms of these innovative therapies, more effective and precise treatment of HCC can be achieved.
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Affiliation(s)
- Xia-Qing Zhou
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Ya-Ping Li
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Shuang-Suo Dang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
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Zamora-Olaya JM, Aparicio-Serrano A, Amado Torres V, Poyato González A, Montero JL, Barrera Baena P, Sánchez Frías M, Ciria Bru R, Briceño Delgado J, De la Mata M, Rodríguez-Perálvarez M. Changes in the Liver Transplant Waiting List after Expanding to the 'Up-to-Seven' Criteria for Hepatocellular Carcinoma. J Pers Med 2023; 13:1670. [PMID: 38138897 PMCID: PMC10744381 DOI: 10.3390/jpm13121670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
We aimed to assess changes in the composition of the waiting list for liver transplantation (LT) after expanding from Milan to "up-to-seven" criteria in patients with hepatocellular carcinoma (HCC). A consecutive cohort of 255 LT candidates was stratified in a pre-expansion era (2016-2018; n = 149) and a post-expansion era (2019-2021; n = 106). The most frequent indication for LT was HCC in both groups (47.7% vs. 43.4%; p = 0.5). The proportion of patients exceeding the Milan criteria in the explanted liver was nearly doubled after expansion (12.5% vs. 21.1%; p = 0.25). Expanding criteria had no effect in drop-out (12.3% vs. 20.4%; p = 0.23) or microvascular invasion rates (37.8% vs. 38.7%; p = 0.93). The length on the waiting list did not increase after the expansion (172 days [IQR 74-282] vs. 118 days [IQR 67-251]; p = 0.135) and was even shortened in the post-expansion HCC subcohort (181 days [IQR 125-232] vs. 116 days [IQR 74-224]; p = 0.04). Tumor recurrence rates were reduced in the post-expansion cohort (15.4% vs. 0%; p = 0.012). In conclusion, expanding from Milan to up-to-seven criteria for LT in patients with HCC had no meaningful impact on the waiting list length and composition, thus offering the opportunity for the adoption of more liberal policies in the future.
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Affiliation(s)
- Javier Manuel Zamora-Olaya
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
| | - Ana Aparicio-Serrano
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
| | - Víctor Amado Torres
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
| | - Antonio Poyato González
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), 28029 Madrid, Spain
| | - José Luis Montero
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), 28029 Madrid, Spain
| | - Pilar Barrera Baena
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), 28029 Madrid, Spain
| | | | - Rubén Ciria Bru
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- Division of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | - Javier Briceño Delgado
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- Division of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | - Manuel De la Mata
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), 28029 Madrid, Spain
| | - Manuel Rodríguez-Perálvarez
- Division of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (J.M.Z.-O.); (A.A.-S.); (V.A.T.); (A.P.G.); (J.L.M.); (P.B.B.); (M.D.l.M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (R.C.B.); (J.B.D.)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), 28029 Madrid, Spain
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