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    Home > Active Ingredient News > Digestive System Information > A Centenary of the Founding of the Party, a Monument in the Medical Field | Interview with Dean Teng Gaojun: "The Confucian Intervention Man" is the No. 1 Treatment Method for Liver Cancer-Embracing the New Era and Bravely Making Innovations

    A Centenary of the Founding of the Party, a Monument in the Medical Field | Interview with Dean Teng Gaojun: "The Confucian Intervention Man" is the No. 1 Treatment Method for Liver Cancer-Embracing the New Era and Bravely Making Innovations

    • Last Update: 2021-05-10
    • Source: Internet
    • Author: User
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    On April 11, it was light rain in Shaoxing.

    The brilliant light and shadow brought a strong sense of the future to the venue of the Chuangjie Summit Forum.

    The reporter of "Physician Daily" looked at the person to be interviewed later on the stage-Dean Teng Gaojun of Zhongda Hospital Affiliated to Southeast University, and was deeply moved by his ardent expectations for interventional therapy.

    Yes, it shouldn't be the missing piece in cancer treatment.

    It is time for someone to speak out for interventional therapy, the number one treatment for liver cancer.

    Dean Teng Gaojun of Zhongda Hospital Affiliated to Southeast University The No.
    1 treatment for liver cancer is intervention.
    Shaoxing is Dean Teng’s hometown.
    Just like this famous cultural city that blends water rhyme poetry and national spirit, the elegant Dean Teng talked about intervention.
    During the treatment, it is difficult to conceal the bloody side.

    Dean Teng introduced that my country is a big country with liver cancer, and the number of patients has continued to increase.

    Statistics show that the number of new liver cancer cases in my country each year accounts for 55% of the world's total.

    According to the latest statistics in 2020, China has 4.
    57 million new cancer cases and 410,000 liver cancers, ranking fifth; China has 3 million deaths from cancer, and 390,000 liver cancers, ranking second.

    Despite the severe form, due to the imperfect early screening system and the lack of attention to high-risk groups, the proportion of patients with liver cancer in my country who are first diagnosed as intermediate and advanced stages is still very high, even with the expansion of surgical indications, The number of patients who can really receive radical surgery is still less than 1/4.
    From the point of view of the number, the proportion of patients suitable for interventional treatment far exceeds that of surgery and other treatments.

    According to statistics, the application rate of arterial embolization chemotherapy (TACE) alone in interventional therapy has reached 61.
    9%.
    Other data show that TACE is also the most commonly used method for the treatment of liver cancer in other countries in North America and Asia.

    Coupled with radiofrequency, microwave, cryotherapy and other ablation techniques that belong to tumor intervention, it can be said that interventional therapy is the veritable number one treatment for liver cancer.

    Interventional therapy opportunities and challenges coexist in the era of system therapy Dean Teng said that interventional therapy with a 40-year history of development has made outstanding contributions in the battle against liver cancer.
    It is not an exaggeration to say that it occupies half of the country.

    Taking TACE as an example, the TACE liver cancer treatment indications recommended by the National Health Commission of my country in the "Primary Liver Cancer Diagnosis and Treatment Standards (2019 Edition)" with Academician Fan Jia as the chairman of the expert group accounted for very large proportions from stage Ib to stage IIIb.
    Large proportions.

    In foreign guidelines, TACE is the gold standard for the treatment of mid-stage liver cancer.

    From this point of view, the situation seems very optimistic, but Dean Teng, who has conducted in-depth research on intervention for many years, still sees a farther level.

    He said that, on the one hand, with the continuous exploration of molecular biology in recent years, new drugs in the field of targeted therapy and immunotherapy have emerged one after another, and the treatment of liver cancer has entered the era of system therapy.

    There are more and more options available, and everyone's attention is getting more and more scattered, and interventional therapy is naturally affected to a certain extent.

    On the other hand, interventional therapy itself also faces many technical challenges.

    Still taking TACE as an example, what is the end point of successful TACE embolization? How to choose TACE Chinese chemotherapeutics? Who are the best suitable people for cTACE and DEB-TACE? The interval between multiple TACEs, the timing of the combination of TACE and ablation, and the selection of ablation methods are all issues that need to be resolved urgently in standardized interventional therapy.

    He emphasized: The therapeutic effect of intervention is based on high-quality interventional technology.
    The TACE technology, which has a history of more than 40 years, still needs to keep pace with the times and continue to improve.

    Furthermore, today, with all aspects of tumor treatment advancing by leaps and bounds, interventional therapy certainly cannot stop at the status quo.

    Dean Teng introduced that the era of system therapy has made interventions face great challenges, but at the same time they have also brought more development opportunities.

    First of all, the efficacy of interventional therapy itself is not lost, even better than targeted or immunotherapy.

    For example, a Meta analysis shows that compared with targeted immunotherapy, TACE can bring better survival benefits for liver cancer patients, and the efficacy and safety of high-quality TACE are significantly better than other non-surgical treatments (ORR 52.
    5%).

    In addition, interventional therapy has been shown to have immunomodulatory effects.

    For example, TACE can play a role in immune activation by causing tumor tissue necrosis, reducing the release of immunosuppressive factors, and changing the phenotype of peripheral immune cells.

    Therefore, interventional therapy has the potential for development in combination with immunotherapy.

    Dean Teng said that from a certain perspective, interventional therapy has already won on the starting line.

    On this basis, if the field of interventional therapy has the courage to embrace the new era, actively innovate, make breakthroughs, and introduce new concepts and new technologies, interventional therapy will undoubtedly be even more powerful.

    The localized production of "secret weapons" benefits more liver cancer patients.
    Talking about embracing the new era, innovation and breakthroughs, Dean Teng disagrees that the reporter regards TACE's "comrades"-Selective Internal Radiation Therapy (SIRT) as "new technology" .

    He said that as early as 30 years ago, Chinese scholars have conducted exploration and research on SIRT, but it is a pity that the technology has not been widely used.

    Although both are injected through the hepatic artery catheter, the therapeutic mechanisms of SIRT and TACE are essentially different.

    In TACE, a catheter is selectively inserted into the target artery supplying the tumor through the hepatic artery, and an appropriate amount of chemoembolizing agent is injected to block the target artery and cause avascular necrosis of the tumor tissue.

    TACE has obvious vascular embolization effect, so post-embolization syndrome is the most common complication of TACE, such as fever, abdominal pain, nausea, vomiting, fatigue and anorexia.

    In SIRT, radioactive microspheres are injected into the target blood supply artery of the tumor through the hepatic artery, and the tumor is evenly distributed along with the blood flow, releasing short-distance and large-dose β-rays to kill tumor cells.

    Its mechanism of action is mainly to kill tumor cells through internal irradiation.

    At the same time, the irradiation of non-tumor sites should be reduced as much as possible or even zero to protect normal tissues.

    The protagonist on the SIRT "stage" is the Y90 glass microsphere, which is essentially a point radioactive source.

    Dean Teng introduced that SIRT has a wide range of clinical applications, and it can reflect the therapeutic value in all stages of liver cancer.

    For early unresectable or non-ablation liver cancer, SIRT can achieve the effect of radical resection.

    For mid-stage liver cancer, SIRT has a better time to tumor progression (TTP) than TACE, and can also allow transplantation after the tumor is downgraded, and the treatment effect is better.

    And as mentioned earlier, SIRT will not cause a series of post-embolism syndromes such as fever and abdominal pain.

    For stage IIIa liver cancer with portal vein tumor thrombus, liver metastases from colorectal cancer, and some cholangiocarcinomas, SIRT therapy also has certain advantages.

    Is there any weakness in such a weapon? The reporter is very curious.

    Dean Teng said that the answer may be "the shelf life is relatively short"-Y90 glass microspheres are currently unable to be produced in China, and because the microspheres have a limited half-life of radioactive materials that can kill tumors, if they are temporarily transported from abroad when patients need to use them.
    , The effect must be unsatisfactory.

    The good news is that Y90 glass microspheres are about to be produced locally in my country.

    Dean Teng said that Y90 glass microspheres realize localized production, and the selection and use of materials are in our own hands.
    This eliminates the effect of radioactive material decay caused by long-distance transportation, and also saves time and cost.
    This will undoubtedly save time and cost.
    Benefit more patients with liver cancer.

    Therefore, the localization of its production is of great significance.

    This year is the first year of the "14th Five-Year Plan", and the country has put forward high requirements for the overall prevention and treatment of liver cancer.

    With the support of new technologies to improve the treatment effect of liver cancer and reduce the mortality rate, we will certainly be more confident.

    Dean Teng said that the second edition of the "Chinese Clinical Practice Guidelines for Transarterial Chemoembolization (TACE) Treatment of Hepatocellular Carcinoma" compiled by the Interventional Physician Branch of the Chinese Medical Doctor Association has been updated and will be issued soon.
    The new version of the guidelines will also incorporate the latest technology, The ideas and data are included to provide a basis for clinical practice.

    ‍‍‍‍‍‍‍‍‍‍‍‍‍‍ ‍‍‍‍‍‍‍‍‍‍‍ ‍‍‍‍‍‍‍‍‍‍‍ ‍‍‍‍‍‍‍‍‍‍‍‍‍ A series of evidence-based medical evidence reveals the answer.

    Y90 glass microsphere SIRT treatment can prolong patient survival, delay tumor progression, and improve some key indicators.
    In 2019, Mount Sinai and others reported that Y90 glass microsphere SIRT treatment can degrade liver cancer, and then undergo liver transplantation or radical resection.

    The results show that SIRT treatment with Y90 glass microspheres can effectively reduce the size and number of liver cancer nodules.

    After SIRT treatment, liver transplantation or hepatectomy can increase the overall survival rate of patients to 97%, 86%, and 86% at 1, 3, and 5 years.

    In 2020, Riad Salem and others published a study (LEGACY study) that confirmed that Y90 is safe and effective.

    The results showed that compared with patients who received liver transplantation or radical resection, the tumor response rate of SIRT-treated patients was 100%, and the best response rate was 88%.

    The patient's 3-year overall survival rate (OS) is as high as 93%.

    Based on the results of this study, the FDA approved Y90 glass microspheres for the treatment of unresectable hepatocellular carcinoma.

    ‍Personalized customized dose to meet the unique radiation dose needs of individual patients and bring better survival benefits.
    In 2020, Garin et al.
    reported the results of a multi-center randomized clinical study (DOSISPHERE-01 study).
    The results showed that the use of individualized dose therapy The overall survival time of patients with liver cancer was 26.
    7 months, while the overall survival time of patients with single-dose therapy was only 10.
    7 months.

    In 2021, Lam et al.
    published a global real-world retrospective study (TARGET study), which confirmed the effectiveness and safety of personalized dose Y90 glass microspheres for the treatment of hepatocellular carcinoma.

    The results showed that through preoperative personalized estimation of tumor absorbed dose, the objective remission rate of Y90 glass microsphere SIRT for tumor treatment reached 70.
    8%, which was nearly 10% higher than that of single-dose treatment, and the tumor response rate increased by 17%.

    The patient's OS was 20.
    3 months.

    Evenly distributed in the target tissue with the bloodstream, the tumor is locally irradiated with high doses, and the non-tumor areas are irradiated as low as possible to protect healthy tissues.
    In 2019, A Johns Hopkins and others published a study.
    The results showed that the use of small doses of highly active glass microspheres is more effective.
    Helps protect healthy liver tissue.

    ‍‍END Typesetting: Xin Ya Editor: Fengfeng Review: Fengfeng For more content, please click: Waiting for you! The third "Young and Middle-aged Cardiovascular Elites" event kicked off unexpectedly|Shanghai doctor Yang Jianmin rescued people from high altitude: the biggest test is that the medicines for emergency facilities are very limited.
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