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Since 2018, targeted therapy for liver cancer represented by lenvatinib and immunotherapy drugs represented by PD-1 immune checkpoint inhibitors have brought an "unprecedented" storm for the treatment of liver cancer in my country.
In particular, the combined treatment strategy of targeted and immunological drugs, and the horizontal and vertical combination of systemic therapy and liver cancer surgery, interventional treatments and other local treatments demonstrated the "power" and potential, including hepatobiliary surgery, radiological intervention, and oncology.
The liver cancer treatment community is refreshed and excited.
These "nuclear warheads" for systemic treatment with double the power are not only promoting the "big integration" of the liver cancer treatment community, but also innovating concepts, changing clinical practice, and reshaping the treatment landscape.
On March 1, 2021, the "2020 National Medical Insurance Reimbursement Catalogue" that includes lenvatinib and other liver cancer system treatment drugs was officially launched, marking the official start of this "big change" in liver cancer treatment.
On March 27, 2021, the "Lexiang Xinsheng-lunvatinib National Medical Insurance Listing Conference" held in Guangzhou attracted top domestic liver cancer treatment experts to gather in Yangcheng.
While "big coffee" from all walks of life witnessed and celebrated this historically significant moment for the treatment of liver cancer in my country, they also brought an academic "symphony" of comprehensive treatment of liver cancer that is fully focused on the future.
Academician Zheng Shusen, Academician of the Chinese Academy of Engineering and Vice President of the Chinese Medical Association, and Professor Liang Lijian from the First Affiliated Hospital of Sun Yat-sen University serve as Honorary Chairmen; Professor Chen Yajin, Director of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; The director, Professor Chen Minshan, delivered wonderful speeches to the conference as the presidium.
The conference was divided into three "movements": "Lesson to transform the universe", "Create the future", and "Enjoy the future", respectively focusing on the development and thinking of transformational therapy for non-resectable liver cancer, and the development and strategy of mid-stage liver cancer interventional combined system therapy.
Future prospects, as well as the latest development of targeted combined immunotherapy and real-world case sharing.The chapter of "Lesuring the Universe" is composed of Professor Wen Tianfu, Director of the Liver Transplant Center of West China Hospital, Deputy Director of the Department of Liver Surgery, Zhongshan Hospital Affiliated to Fudan University, Professor Sun Huichuan, Deputy Director of the Institute of Liver Cancer, Fudan University, and Fudan University.
Professor Chen Jinhong, the chief surgeon of Huashan Hospital affiliated to the university, made a keynote speech.
Surgical resection is currently the most likely means to bring long-term survival for liver cancer patients.
However, more than 60% of liver cancers in my country have progressed to unresectable advanced liver cancer when they are discovered.
How to transform more unresectable liver cancer into surgically resectable liver cancer has become a hot topic in the treatment of liver cancer, and it is also an important direction of liver cancer clinical research.
The high objective response rate (ORR) and disease control rate (DCR) brought by lenvatinib combined with immunotherapy obviously brings new opportunities for the conversion therapy of unresectable liver cancer.
In 2018, the American Society of Clinical Oncology (ASCO) conference announced for the first time that lenvatinib combined with PD-1 immune checkpoint inhibitor pembrolizumab (commonly known as "cola combination") first-line treatment of unresectable hepatocellular carcinoma stage Ib The results of the study demonstrated the power of lenvatinib combined with PD-1 monoclonal antibody.
The updated research results released by the ASCO conference in 2020 show that the ORR of the "Cola" combination evaluated according to the mRECIST standard reached 46%, and the median overall survival (mOS) reached 22.
0 months.
In 2020, ASCO released updated data of KEYNOTE-524, ORR 46% (mRECIST per IIR), DCR 88% (mRECIST per IIR), mOS 22.
0 months Professor Wen Tianfu pointed out that the liver cancer system treatment drugs, especially lenvatinib, etc.
Multi-target small-molecule anti-tumor drugs and their combined strategies with immunotherapy have brought higher ORR, broadened the indications for surgery, and allowed those unresectable advanced liver cancers to be transformed into surgically resectable after tumor downgrading.
Patients with incurable advanced liver cancer have a chance to be cured. Lunvatinib combined with PD-1 drugs to improve ORR, bringing more possibilities for conversion therapy At the 2020 ASCO meeting, the liver surgery team led by Academician Fan Jia and Professor Zhou Jian from Zhongshan Hospital of Fudan University reported on the real world Zhonglun The efficacy of targeted drugs such as vatinib in combination with different PD1 antibodies for transformational therapy of unresectable liver cancer.
The results showed that as of the publication of the study, 11 of the 60 patients included in the study (18.
3%) met the resection criteria, and 9 had undergone surgical resection.
At this conference, Professor Sun Huichuan shared specific cases.
Professor Sun Huichuan believes that in the future, local therapy combined with systemic drugs can play a greater role in the down-stage conversion therapy of liver cancer and have a broader application prospect.
The combination of a variety of local and systemic treatment modes has become a hot topic in translational therapy research.
Another hot topic in liver cancer surgery is the prevention of recurrence after liver cancer surgery.
Although surgical resection is currently the most important method of liver cancer treatment, the five-year recurrence rate of surgery has reached 60%, and the high postoperative recurrence rate is one of the most important obstacles hindering the improvement of liver cancer treatment.
At the 2020 ASCO conference, the surgical team of Huashan Hospital affiliated to Fudan University led the clinical study of lenvatinib combined with hepatic artery chemoembolization (TACE) for the treatment of patients with high-risk hepatocellular carcinoma after surgery.
LANCE (NCT03838796) released an interim analysis result.
The results showed that the combined treatment regimen can prolong the disease-free survival (DFS) time compared with the TACE regimen alone, with a median DFS of 12.
0 (95% CI 8.
0-NA) months, and 8.
0 (95% CI 6.
0-12.
0) in the TACE group.
The risk of disease recurrence was reduced by 50% in the combination therapy group (HR, 0.
5, 95% CI, 0.
3-1.
0, p=0.
0359).
The preliminary results of the LANCE study are currently in the field of prevention of high-risk recurrence after liver cancer surgery.
Except for antiviral therapy and TACE, other methods lack high-level evidence-based medical evidence, and there is an urgent need to obtain validated new treatment strategies. Lenvatinib is significantly better than sorafenib in terms of progression-free survival (PFS), time to disease progression (TTP), ORR, etc.
brought by the treatment of unresectable hepatocellular carcinoma.
Professor Chen Jinhong pointed out that although TACE is an effective adjuvant treatment for patients with high risk of recurrence after surgery, the efficacy of TACE alone may still be limited.
The LANCE study selected a strong combination of TACE and lenvatinib as an adjuvant treatment plan to improve the efficacy.
Transverse Joint Creation of the Future "Creation of the Future" consists of Professor Xiaoli Zhu from the Department of Interventional Therapy of the First Affiliated Hospital of Soochow University, Professor Ming Zhao from the Imaging and Minimally Invasive Intervention Center of Sun Yat-sen University Tumor Hospital, and the director of the Department of Interventional Oncology, the First Affiliated Hospital of Sun Yat-Sen University.
Professor Li Jiaping, vice chairman of China CSCO Interventional Radiology Committee, made a keynote speech.
Interventional treatment of liver cancer is a local treatment method that embolizes blood vessels and/or anticancer drugs, or radiotherapy microspheres after the femoral artery is catheterized into the hepatic artery, including TACE, hepatic artery infusion chemotherapy (HAIC), and hepatic artery embolization (TAE), and hepatic artery radiotherapy embolization (TARE).
Currently in China, TACE has become the first choice for non-surgical treatment of primary hepatocellular carcinoma (HCC), and is currently the most widely used regimen, accounting for 91.
44% of all interventional treatments in clinical practice.
In the "Specifications for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition)" issued by the National Health Commission in 2019, TACE treatment has a wide range of indications, covering liver cancer stages from stage Ib to stage IIIb, including patients with poor prognosis in current treatment.
Hepatocellular carcinoma with portal vein tumor thrombus.
The clinical staging of liver cancer covered by TACE treatment recommended in the "Standards for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition)" However, TACE treatment of advanced liver cancer also has limitations.
On the one hand, it is difficult to achieve complete tumor necrosis in a single embolization of TACE, and the biological characteristics of residual cancer cells can be changed in hypoxic environment, thereby having stronger proliferation and invasion ability; on the other hand, TACE can affect hepatitis, liver cirrhosis, etc.
The patient's liver function causes a greater burden.
Professor Xiaoli Zhu shared the experience and cases of TACE combined with targeted immunotherapy for unresectable hepatocellular carcinoma.
Professor Zhu Xiaoli believes that TACE combined immunization and targeting have great clinical application prospects in the treatment of mid-stage liver cancer, but "interventionists" need to continue to explore.
While improving and perfecting interventional technology, "interventionists" must become research-type clinical scientists.
Professor Ming Zhao shared the results of multiple clinical studies of lenvatinib combined with TACE treatment including mid-term HCC with high tumor burden, TACE-refractory mid-term HCC, and patients with HCC combined with PVTT, showing the mid-term treatment of lenvatinib combined with TACE The great potential of liver cancer.
Professor Ming Zhao believes that lenvatinib-based treatment programs help to prolong PFS and also bring breakthrough ORR benefits to system therapy; from clinical trial data to real-world applications, they have shown significant anti-tumor effects.
Professor Li Jiaping gave a report entitled "Practice and Exploration of Combined Interventional Systemic Therapy for Liver Cancer" and shared multiple cases of targeted immune combined interventional therapy based on the discussion of MDT.
Professor Li Jiaping emphasized that interventional and targeted immunotherapy have a synergistic effect.
For example, molecular anti-vascular therapy changes the microenvironment of tumor growth and has a significant synergistic effect on local interventional therapy.
Interventional therapy activates T cell response and tumor cell PD- L1 expression makes immunotherapy more sensitive.
Therefore, the combination with system therapy will allow interventional therapy to "patch the wings" and play a leading role in the field of mid-stage liver cancer treatment.
The “Enjoy the Future” link based on targeting was delivered by Professor Li Qiu, deputy director of the Cancer Center of West China Hospital of Sichuan University, Professor Zhou Jun from Peking University Cancer Hospital, and Professor Chen Yi from the Department of Liver Oncology, Zhongshan Hospital, Fudan University.
Although it is the last link of the conference, as the core driving force of "Lesuring the Universe" and "creating the future", the latest developments and clinical practice of targeted combined immune systemic therapy brought this conference to the academic climax.
Professor Chen Yi shared the systemic mechanism of targeted and immunotherapy to transform the tumor microenvironment, and emphasized the synergy between the two; Professor Zhou Jun demonstrated through actual cases that targeted combined immunotherapy and various local treatments combined to treat liver cells On the clinical application potential and challenges of cancer, Professor Li Qiu systematically reviewed and summarized the latest research progress of various types of combined treatments for targeting and immunity, and expounded the current hotspots and directions of systemic drug therapy research.
Ongoing clinical research on immunotherapy combined with anti-angiogenesis therapy Professor Li Qiu pointed out that vascular targeted drugs combined with immune checkpoint inhibitors are currently a hot spot in the research of various solid tumors; in the treatment of hepatocellular carcinoma, even in immunotherapy In the era, targeted drugs represented by lenvatinib are still the cornerstone of treatment.
From the conversion therapy of unresectable liver cancer to the prevention of high-risk recurrence of liver cancer during the perioperative period, from the intervention-led mid-term comprehensive therapy of liver cancer to the comprehensive therapy of liver cancer based on targeting and immunity, it is not difficult to see that the systemic therapy of liver cancer is leading The “big change” in liver cancer treatment is sweeping the entire field of liver cancer treatment, reshaping the pattern of liver cancer treatment.
At present, no one can make a final conclusion on the future trend and pattern.
The only constant possibility is change.
But what is certain is that this "big change" that changes the clinical practice of liver cancer will improve the long-term survival prognosis of patients with advanced liver cancer in my country, and the entry of lenvatinib into the medical insurance reimbursement list will be a milestone in this change and will help Push this change to sweep through at a faster speed.
In particular, the combined treatment strategy of targeted and immunological drugs, and the horizontal and vertical combination of systemic therapy and liver cancer surgery, interventional treatments and other local treatments demonstrated the "power" and potential, including hepatobiliary surgery, radiological intervention, and oncology.
The liver cancer treatment community is refreshed and excited.
These "nuclear warheads" for systemic treatment with double the power are not only promoting the "big integration" of the liver cancer treatment community, but also innovating concepts, changing clinical practice, and reshaping the treatment landscape.
On March 1, 2021, the "2020 National Medical Insurance Reimbursement Catalogue" that includes lenvatinib and other liver cancer system treatment drugs was officially launched, marking the official start of this "big change" in liver cancer treatment.
On March 27, 2021, the "Lexiang Xinsheng-lunvatinib National Medical Insurance Listing Conference" held in Guangzhou attracted top domestic liver cancer treatment experts to gather in Yangcheng.
While "big coffee" from all walks of life witnessed and celebrated this historically significant moment for the treatment of liver cancer in my country, they also brought an academic "symphony" of comprehensive treatment of liver cancer that is fully focused on the future.
Academician Zheng Shusen, Academician of the Chinese Academy of Engineering and Vice President of the Chinese Medical Association, and Professor Liang Lijian from the First Affiliated Hospital of Sun Yat-sen University serve as Honorary Chairmen; Professor Chen Yajin, Director of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; The director, Professor Chen Minshan, delivered wonderful speeches to the conference as the presidium.
The conference was divided into three "movements": "Lesson to transform the universe", "Create the future", and "Enjoy the future", respectively focusing on the development and thinking of transformational therapy for non-resectable liver cancer, and the development and strategy of mid-stage liver cancer interventional combined system therapy.
Future prospects, as well as the latest development of targeted combined immunotherapy and real-world case sharing.The chapter of "Lesuring the Universe" is composed of Professor Wen Tianfu, Director of the Liver Transplant Center of West China Hospital, Deputy Director of the Department of Liver Surgery, Zhongshan Hospital Affiliated to Fudan University, Professor Sun Huichuan, Deputy Director of the Institute of Liver Cancer, Fudan University, and Fudan University.
Professor Chen Jinhong, the chief surgeon of Huashan Hospital affiliated to the university, made a keynote speech.
Surgical resection is currently the most likely means to bring long-term survival for liver cancer patients.
However, more than 60% of liver cancers in my country have progressed to unresectable advanced liver cancer when they are discovered.
How to transform more unresectable liver cancer into surgically resectable liver cancer has become a hot topic in the treatment of liver cancer, and it is also an important direction of liver cancer clinical research.
The high objective response rate (ORR) and disease control rate (DCR) brought by lenvatinib combined with immunotherapy obviously brings new opportunities for the conversion therapy of unresectable liver cancer.
In 2018, the American Society of Clinical Oncology (ASCO) conference announced for the first time that lenvatinib combined with PD-1 immune checkpoint inhibitor pembrolizumab (commonly known as "cola combination") first-line treatment of unresectable hepatocellular carcinoma stage Ib The results of the study demonstrated the power of lenvatinib combined with PD-1 monoclonal antibody.
The updated research results released by the ASCO conference in 2020 show that the ORR of the "Cola" combination evaluated according to the mRECIST standard reached 46%, and the median overall survival (mOS) reached 22.
0 months.
In 2020, ASCO released updated data of KEYNOTE-524, ORR 46% (mRECIST per IIR), DCR 88% (mRECIST per IIR), mOS 22.
0 months Professor Wen Tianfu pointed out that the liver cancer system treatment drugs, especially lenvatinib, etc.
Multi-target small-molecule anti-tumor drugs and their combined strategies with immunotherapy have brought higher ORR, broadened the indications for surgery, and allowed those unresectable advanced liver cancers to be transformed into surgically resectable after tumor downgrading.
Patients with incurable advanced liver cancer have a chance to be cured. Lunvatinib combined with PD-1 drugs to improve ORR, bringing more possibilities for conversion therapy At the 2020 ASCO meeting, the liver surgery team led by Academician Fan Jia and Professor Zhou Jian from Zhongshan Hospital of Fudan University reported on the real world Zhonglun The efficacy of targeted drugs such as vatinib in combination with different PD1 antibodies for transformational therapy of unresectable liver cancer.
The results showed that as of the publication of the study, 11 of the 60 patients included in the study (18.
3%) met the resection criteria, and 9 had undergone surgical resection.
At this conference, Professor Sun Huichuan shared specific cases.
Professor Sun Huichuan believes that in the future, local therapy combined with systemic drugs can play a greater role in the down-stage conversion therapy of liver cancer and have a broader application prospect.
The combination of a variety of local and systemic treatment modes has become a hot topic in translational therapy research.
Another hot topic in liver cancer surgery is the prevention of recurrence after liver cancer surgery.
Although surgical resection is currently the most important method of liver cancer treatment, the five-year recurrence rate of surgery has reached 60%, and the high postoperative recurrence rate is one of the most important obstacles hindering the improvement of liver cancer treatment.
At the 2020 ASCO conference, the surgical team of Huashan Hospital affiliated to Fudan University led the clinical study of lenvatinib combined with hepatic artery chemoembolization (TACE) for the treatment of patients with high-risk hepatocellular carcinoma after surgery.
LANCE (NCT03838796) released an interim analysis result.
The results showed that the combined treatment regimen can prolong the disease-free survival (DFS) time compared with the TACE regimen alone, with a median DFS of 12.
0 (95% CI 8.
0-NA) months, and 8.
0 (95% CI 6.
0-12.
0) in the TACE group.
The risk of disease recurrence was reduced by 50% in the combination therapy group (HR, 0.
5, 95% CI, 0.
3-1.
0, p=0.
0359).
The preliminary results of the LANCE study are currently in the field of prevention of high-risk recurrence after liver cancer surgery.
Except for antiviral therapy and TACE, other methods lack high-level evidence-based medical evidence, and there is an urgent need to obtain validated new treatment strategies. Lenvatinib is significantly better than sorafenib in terms of progression-free survival (PFS), time to disease progression (TTP), ORR, etc.
brought by the treatment of unresectable hepatocellular carcinoma.
Professor Chen Jinhong pointed out that although TACE is an effective adjuvant treatment for patients with high risk of recurrence after surgery, the efficacy of TACE alone may still be limited.
The LANCE study selected a strong combination of TACE and lenvatinib as an adjuvant treatment plan to improve the efficacy.
Transverse Joint Creation of the Future "Creation of the Future" consists of Professor Xiaoli Zhu from the Department of Interventional Therapy of the First Affiliated Hospital of Soochow University, Professor Ming Zhao from the Imaging and Minimally Invasive Intervention Center of Sun Yat-sen University Tumor Hospital, and the director of the Department of Interventional Oncology, the First Affiliated Hospital of Sun Yat-Sen University.
Professor Li Jiaping, vice chairman of China CSCO Interventional Radiology Committee, made a keynote speech.
Interventional treatment of liver cancer is a local treatment method that embolizes blood vessels and/or anticancer drugs, or radiotherapy microspheres after the femoral artery is catheterized into the hepatic artery, including TACE, hepatic artery infusion chemotherapy (HAIC), and hepatic artery embolization (TAE), and hepatic artery radiotherapy embolization (TARE).
Currently in China, TACE has become the first choice for non-surgical treatment of primary hepatocellular carcinoma (HCC), and is currently the most widely used regimen, accounting for 91.
44% of all interventional treatments in clinical practice.
In the "Specifications for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition)" issued by the National Health Commission in 2019, TACE treatment has a wide range of indications, covering liver cancer stages from stage Ib to stage IIIb, including patients with poor prognosis in current treatment.
Hepatocellular carcinoma with portal vein tumor thrombus.
The clinical staging of liver cancer covered by TACE treatment recommended in the "Standards for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition)" However, TACE treatment of advanced liver cancer also has limitations.
On the one hand, it is difficult to achieve complete tumor necrosis in a single embolization of TACE, and the biological characteristics of residual cancer cells can be changed in hypoxic environment, thereby having stronger proliferation and invasion ability; on the other hand, TACE can affect hepatitis, liver cirrhosis, etc.
The patient's liver function causes a greater burden.
Professor Xiaoli Zhu shared the experience and cases of TACE combined with targeted immunotherapy for unresectable hepatocellular carcinoma.
Professor Zhu Xiaoli believes that TACE combined immunization and targeting have great clinical application prospects in the treatment of mid-stage liver cancer, but "interventionists" need to continue to explore.
While improving and perfecting interventional technology, "interventionists" must become research-type clinical scientists.
Professor Ming Zhao shared the results of multiple clinical studies of lenvatinib combined with TACE treatment including mid-term HCC with high tumor burden, TACE-refractory mid-term HCC, and patients with HCC combined with PVTT, showing the mid-term treatment of lenvatinib combined with TACE The great potential of liver cancer.
Professor Ming Zhao believes that lenvatinib-based treatment programs help to prolong PFS and also bring breakthrough ORR benefits to system therapy; from clinical trial data to real-world applications, they have shown significant anti-tumor effects.
Professor Li Jiaping gave a report entitled "Practice and Exploration of Combined Interventional Systemic Therapy for Liver Cancer" and shared multiple cases of targeted immune combined interventional therapy based on the discussion of MDT.
Professor Li Jiaping emphasized that interventional and targeted immunotherapy have a synergistic effect.
For example, molecular anti-vascular therapy changes the microenvironment of tumor growth and has a significant synergistic effect on local interventional therapy.
Interventional therapy activates T cell response and tumor cell PD- L1 expression makes immunotherapy more sensitive.
Therefore, the combination with system therapy will allow interventional therapy to "patch the wings" and play a leading role in the field of mid-stage liver cancer treatment.
The “Enjoy the Future” link based on targeting was delivered by Professor Li Qiu, deputy director of the Cancer Center of West China Hospital of Sichuan University, Professor Zhou Jun from Peking University Cancer Hospital, and Professor Chen Yi from the Department of Liver Oncology, Zhongshan Hospital, Fudan University.
Although it is the last link of the conference, as the core driving force of "Lesuring the Universe" and "creating the future", the latest developments and clinical practice of targeted combined immune systemic therapy brought this conference to the academic climax.
Professor Chen Yi shared the systemic mechanism of targeted and immunotherapy to transform the tumor microenvironment, and emphasized the synergy between the two; Professor Zhou Jun demonstrated through actual cases that targeted combined immunotherapy and various local treatments combined to treat liver cells On the clinical application potential and challenges of cancer, Professor Li Qiu systematically reviewed and summarized the latest research progress of various types of combined treatments for targeting and immunity, and expounded the current hotspots and directions of systemic drug therapy research.
Ongoing clinical research on immunotherapy combined with anti-angiogenesis therapy Professor Li Qiu pointed out that vascular targeted drugs combined with immune checkpoint inhibitors are currently a hot spot in the research of various solid tumors; in the treatment of hepatocellular carcinoma, even in immunotherapy In the era, targeted drugs represented by lenvatinib are still the cornerstone of treatment.
From the conversion therapy of unresectable liver cancer to the prevention of high-risk recurrence of liver cancer during the perioperative period, from the intervention-led mid-term comprehensive therapy of liver cancer to the comprehensive therapy of liver cancer based on targeting and immunity, it is not difficult to see that the systemic therapy of liver cancer is leading The “big change” in liver cancer treatment is sweeping the entire field of liver cancer treatment, reshaping the pattern of liver cancer treatment.
At present, no one can make a final conclusion on the future trend and pattern.
The only constant possibility is change.
But what is certain is that this "big change" that changes the clinical practice of liver cancer will improve the long-term survival prognosis of patients with advanced liver cancer in my country, and the entry of lenvatinib into the medical insurance reimbursement list will be a milestone in this change and will help Push this change to sweep through at a faster speed.
