CSCO BC Annual Meeting . . . Professor Li Jin, Professor Jiang Zefei: Breast cancer bone metastasis ushered in innovative drugs.

From July 10 to 11, 2020, CSCO breast cancer annual conference and 2020 national breast cancer conference were successfully held in Beijing! The conference covered the related contents of "scientific frontier, innovative drugs, guideline consensus, famous experts' perspective, big data and artificial intelligence". At the same time, a special session on the treatment of bone metastasis of breast cancer was set up. A number of well-known experts in the field of oncology attended the academic feast, sharing the latest progress and valuable experience of classification and hierarchical treatment of breast cancer treatment and recurrence and metastasis in different stages.during the meeting, we specially invited the chairman of the conference, Professor Li Jin, President of Beijing Sisco cancer clinical research foundation, and Professor Jiang zefei, vice president of CSCO, to share the treatment progress of breast cancer bone metastasis and the development trend of innovative drugs.Professor Li Jin, chief physician, doctoral supervisor, director of oncology department, Dongfang Hospital, Tongji University, chairman of the Asian Cancer Alliance (FACO), President of Beijing Sisco cancer clinical research foundation, former president of CSCO, chairman of CSCO drug safety special committee, and professional committee of colorectal cancer of Chinese Medical Association Vice chairman Professor Jiang zefei, chief physician, doctoral supervisor, director of breast cancer Department of the fifth medical center of PLA General Hospital St.Gallen China food and Drug Administration (SFDA) ）What are the new topics and new progress of CSCO breast cancer annual meeting of new drug review experts? Professor Jiang zefei: CSCO breast cancer annual meeting is also the 2020 national breast cancer conference, with rich and wonderful contents.in the science frontier forum, academicians Yu Jinming and Wang Xiaodong were invited to introduce the opportunities and challenges of innovative talents, discipline construction and biomedical innovation. As well as famous oncologists in China, Professor Li Jin and Professor Wang Jie shared the innovation road of China's anti-tumor drug research and development and scientific research exploration of cancer precision medicine based on clinical problems.we invited Dr. Chen Xiaoyuan from Tsinghua University and scientists in the research and development field to talk about clinical development in China facing the needs of patients.academician song Erwei, Professor Shao Zhimin, Professor Xu binghe, Professor Liu Yinhua, Professor Wu Jiong and other domestic leading figures in the field of breast cancer were invited to review the international and domestic academic progress in this year.colleagues of CSCO breast cancer committee also shared the work done in the past year, interpreting the feedback of doctors at all levels since the release of CSCO breast cancer guidelines in April.the conference adopts the way of online and offline interaction and discussion, and the newly developed tumor artificial intelligence assistant decision-making system is set up in the special topic, which can calculate the effective rate, effective time, toxicity, reimbursement amount of medical insurance and the expenses that patients need to pay in a few seconds.taking this opportunity, we hope to promote the artificial intelligence system throughout the country, so that doctors from all over the country can discuss with experts the problems and puzzles in the treatment.among many problems that affect the quality of life of cancer patients, "bone metastasis" is the most prominent, which solid tumors are most prone to bone metastasis? What are the current treatments for bone metastases? Can the quality of life of patients be improved? With the innovation and progress of modern medicine, what new bone improvement drugs are there? What benefits will these drugs bring to patients? Professor Li Jin: bone metastasis is a problem that needs special attention in the process of tumor treatment.there are differences in the incidence of bone metastases among different tumors. For example, breast cancer and lung cancer are prone to bone metastasis. These tumors are osteophilic and easy to immerse in the bone, resulting in bone dissolution, bone destruction, and finally fracture in severe cases.bone metastases can easily cause bone related events such as pain, hypercalcemia and fracture, which affect the quality of life and survival time of patients.the treatment of bone metastases mainly includes local treatment and systemic treatment.local treatment includes radiotherapy, ablation, and bone cement.systemic therapy includes bisphosphonates, and zoledronic acid, the third generation bisphosphonate, is commonly used at present, which can control the occurrence or progress of bone metastasis to a great extent.although bisphosphonates have been used in the treatment of bone metastases for more than ten years, the curative effect is still not satisfactory.recently, a new generation of targeted drug deshumab has been developed in the world, which can inhibit the formation of osteoclasts and reduce bone destruction. deshumab was approved for entry into China in May. the application of desumumab can reduce the occurrence of bone related events and reduce the progress of bone metastasis. I believe that desumumab can be used more widely in bone metastasis in the future. bone modification drugs are the main drugs for the treatment of breast cancer bone metastasis, including traditional bisphosphonates and new drug dessummab. can you talk about the difference between the mechanism of action and the efficacy of the two drugs? Prof. Jiang zefei: bone improvement drugs are a large class of drugs, and bisphosphonates are the first to be used. the first generation is chlorophosphonate, the second generation is pamidronate, and the third is zoledronic acid. the greatest progress of the second and third generation is better curative effect and more convenient infusion. pamidronate needs to be infused for more than 2-4 hours, while zoledronic acid infusion time can be shortened to half an hour or even 15 minutes, but they are all Diphosphonates with the same mechanism. the current bone modification drugs also include the antibodies such as deshumab, which is the first targeted RANKL inhibitor, which can block the binding of rank and RANKL, and can inhibit not only osteoclasts but also tumor cells. due to the unique mechanism of action of desumumab, the initial efficacy is better than zoledronic acid, which can bring greater benefits to patients. patients who had been treated with zoledronic acid in the past can also achieve good curative effect by changing to desumumab. in addition, dessummab can be injected subcutaneously, which is more convenient to use. Especially during the epidemic period, patients are not convenient to come to the hospital for infusion and can receive subcutaneous injection outside the hospital. how to judge the medication time of bone improvement drugs? Should it be used in the diagnosis of bone metastases? Or should I use it when I have bone pain or other symptoms? Prof. Jiang zefei: in 2005, under the guidance of academician Sun Yan, we promulgated the expert consensus on the diagnosis and treatment of bone metastases of malignant tumors. In the consensus, it was mentioned that bone improvement drugs should be used after patients have been diagnosed with bone metastases through imaging examination, such as CT and X-ray, even if there is no pain, rather than after the symptoms appear. bone modifying drugs are not only painkillers, but also can inhibit the activity of osteoclasts and control bone destruction in the process of bone metastasis. therefore, it is not only used for bone pain symptoms, but also for diagnosis of bone metastasis. in the process of bone metastasis, we should advocate the use of bone improvement drugs in the whole process, and we should monitor the adverse reactions during the use process, and we should also determine the use time according to the patient's physical condition and bone metastasis. if the patient is mainly bone metastases, we should continue to use bone improvement drugs; however, if the patients have severe late stage metastasis and can no longer benefit the patients, we suggest to stop using bone improvement drugs. the first RANKL inhibitor deshumab has been launched in China. What do you think of its future status in the treatment of bone metastasis of breast cancer? Prof. Jiang zefei: deshumab is an innovative drug. Five or six years ago, I had the honor to cooperate with Professor Zhang Li in Guangzhou in the clinical study of 450 patients with malignant tumors in China. in the clinical research design, protocol discussion, patient management and follow-up work, there are many experiences. First, it is easy to use, and the second is significant curative effect. therefore, we are also looking forward to the benefits of desmodizumab in patients with bone metastases from tumors, including breast cancer bone metastases, lung cancer bone metastases, prostate cancer bone metastases, and multiple myeloma. in fact, we have already started to use desflumab, which shows a good therapeutic value. Of course, we also hope that clinicians can choose the right patients and apply them reasonably at the right time. China's clinical research has entered a stage of rapid development, and Chinese scholars have begun to gradually participate in global multi center clinical research. Chinese local innovative pharmaceutical enterprises are also increasing cooperation with international pharmaceutical companies, increasing R & D cooperation or introducing suitable foreign drugs into China as soon as possible. What do you think this change means for the pharmaceutical industry? What does it mean for Chinese patients? Professor Li Jin: if the products of foreign companies apply for listing in China, it will take more than five years. If Chinese patients want to use them, they need to buy them abroad or obtain them through improper channels. This is very painful for Chinese patients and it is difficult to use the latest global drugs. on the one hand, the R & D ability of Chinese enterprises is weak; on the other hand, foreign enterprises are not interested in China's market, and the application and registration procedures are complex, which affects the speed of Chinese patients using world-class products. If foreign multinational enterprises cooperate with Chinese enterprises to develop world-class products in China simultaneously, it can help Chinese enterprises improve the ability of new drug research and development, at the same time, it can also enable Chinese patients to use international innovative products as soon as possible, and obtain better survival, so this is a good news for our Chinese patients. in recent years, with the support of the national pharmaceutical industry policy, innovative anti-tumor drug R & D enterprises like Baiji have been rising. How do you view the development prospects of innovative drugs in the future and what expectations do you have for innovative companies like Baiji? Prof. Li Jin: among the national pharmaceutical enterprises in China, Baiji Shenzhou is a relatively unique enterprise. first of all, it has been established for a short time, but it has made great progress. Second, it has a good product line, strong R & D ability, and its innovative products are quickly recognized by the US FDA, which is relatively rare among Chinese enterprises. For example, zebitinib has obtained accelerated approval in the US FDA, which is a model for Chinese enterprises to learn from. Third, we should pay attention to the development of innovative products and cooperation with international pharmaceutical enterprises. For example, deshumab is the result of the cooperation between Baiji and Amgen. at the same time, Baiji introduces the new products developed by Amgen in the world into China, providing first-class services for cancer patients in China. such a Sino foreign joint venture is a virtuous circle for enterprises,