Primary liver cancer is one of the leading causes of cancer mortality worldwide, with hepatocellular carcinoma (HCC) being the most prevalent type of liver cancer. The prognosis of patients with advanced, unresectable HCC has historically been poor. However, with the emergence of immunotherapy, specifically immune checkpoint inhibitors (ICIs), there is reason for optimism. Nevertheless, ICIs do not come without risk, especially when administered in patients with HCC, given their potential underlying poor hepatic reserve. Given their novelty in the management of HCC, there are few studies to date specifically investigating ICI-related side effects on the liver in patients with underlying HCC. This review will serve as a guide for clinicians on ICIs’ role in the management of HCC and their potential side effect profile. There will be a discussion on ICI-related hepatotoxicity, the potential for hepatitis B and C reactivation with ICI use, the potential for the development of autoimmune hepatitis with ICI use, and the risk of gastrointestinal bleeding with ICI use. As ICIs become more commonplace as a treatment option in patients with advanced HCC, it is imperative that clinicians not only understand the mechanism of action of such agents but also understand and are able to identify hepatic-related side effects.
原发性肝癌是全球癌症死亡的主要原因之一，其中肝细胞癌（HCC）是最常见的肝癌类型。晚期不可切除肝细胞癌患者的预后历来较差。然而，随着免疫疗法特别是免疫检查点抑制剂（ICIs）的出现，治疗前景呈现乐观态势。尽管如此，ICIs并非没有风险，尤其对于肝功能储备可能较差的HCC患者。鉴于ICIs在HCC治疗中的应用尚属新兴领域，目前专门针对ICIs对HCC患者肝脏相关副作用的研究仍较为有限。本综述旨在为临床医生提供关于ICIs在HCC治疗中的作用及其潜在副作用谱系的指导，将系统探讨ICIs相关的肝毒性、使用ICIs可能引发的乙型/丙型肝炎病毒再激活风险、自身免疫性肝炎发生可能性以及消化道出血风险。随着ICIs在晚期HCC治疗中日益普及，临床医生不仅需要理解此类药物的作用机制，更需全面认知并准确识别其可能引发的肝脏相关副作用。
肿瘤(癌症)患者之家