echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Digestive System Information > Is it difficult to diagnose and treat newly diagnosed or advanced liver cancer?

    Is it difficult to diagnose and treat newly diagnosed or advanced liver cancer?

    • Last Update: 2022-01-26
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com
    *Only for medical professionals to read and reference Professor Zhao Ming's in-depth analysis of the research and advanced HCC treatment On December 14, 2021, the Journal of Clinical Oncology, an authoritative journal in the field of global cancer treatment, published an online article in Zhongshan The research results of Professor Zhao Ming's team from the University Cancer Center: Hepatic arterial infusion of oxaliplatin combined with fluorouracil (HAIC-FOLFOX) interventional therapy versus sorafenib molecular targeted therapy for advanced hepatocellular carcinoma (HCC): a biomolecular exploration Sexual, Randomized, Phase III Clinical Study (FOHAIC-1) [Arterial Chemotherapy of Oxaliplatin Plus Fluorouracil Versus Sorafenib in Advanced Hepatocellular Carcinoma: A Biomolecular Exploratory, Randomized, Phase III Trial (FOHAIC-1)][1]
    .

    The study is the world's first randomized phase III clinical trial comparing HAIC-FOLFOX interventional therapy with standard treatment sorafenib
    .

    This issue of "Medical Frontline" sincerely invites Professor Zhao Ming, the corresponding author of the study, to conduct an in-depth analysis of the study and the treatment of advanced HCC
    .

    Q: What is the current status of diagnosis and treatment of patients with advanced hepatocellular carcinoma in my country? What was the original intention of you and your team for this research? ▎Professor Zhao Ming: China is a country with a high incidence of hepatocellular carcinoma (HCC), and its morbidity and mortality ranks first in the world.
    70% of HCC patients in China are initially diagnosed as middle-advanced and lose the chance of radical resection[2]
    .

    Chronic viral hepatitis B is a major risk factor for HCC in my country
    .

    Although hepatitis B vaccination and anti-hepatitis B treatment have made great progress in recent years, there are still many hepatitis B patients who fail to pay enough attention to the systematic treatment and follow-up of their underlying diseases, which leads to aggravation of the disease, and some of them eventually transform into HCC.
    late
    .

    Targeted/immunotherapy or interventional therapy is currently the commonly used treatment for patients with advanced HCC, but previous studies have shown that they are not satisfactory for the treatment of advanced HCC with severe intrahepatic tumor burden and large vessel tumor thrombus invasion.
    More than 1 year
    .

    Based on this, considering that hepatic arterial infusion therapy has shown good efficacy in the treatment of solid tumors such as colorectal cancer, the research team hopes to further improve patient survival by applying this method to the treatment of advanced HCC.
    the original intention
    .

    Q: Could you please introduce the findings of this study? What do you think is novel about this research? ▎Professor Ming Zhao: First of all, Sorafenib is the first approved first-line treatment for patients with advanced HCC, but there is still an unmet clinical need in terms of prolonging patient survival and improving tolerance
    .

    The FOHAIC-1 study promotes interventional therapy in advanced (BCLC-C stage) patients [transarterial chemoembolization (TACE) has also been used in advanced patients in the past, but failed to obtain better clinical benefits than standard therapy.
    ], the results of this study showed that the median overall survival (OS) in the HAIC-FO group compared with the sorafenib group was 13.
    9 months vs.
    8.
    2 months (P<0.
    001); 16 patients in the HAIC-FO group (12.
    3 %) patients achieved tumor downstaging, 15 of whom received radical surgery or ablation, and patients who received local therapy had a final median OS of 20.
    8 months, a 1-year OS rate of 93.
    8%, and significantly improved survival; in addition, In the subgroup with local high-risk risk factors, the HAIC-FO group also showed the advantage of a good survival benefit, with an OS of about 10.
    8 months
    .

    Studies have shown that HAIC-FO has better clinical efficacy and patient benefit than sorafenib in the first-line treatment of advanced HCC with initial diagnosis (or with a large intrahepatic tumor burden and large vessel tumor thrombus invasion).
    Based on the current targeted and immune combination regimens), it is suggested that it may be used as a first-line treatment for such patients alone or in combination with first-line immune/targeted therapy in the future
    .

    Secondly, the research object and prediction model of FOHAIC-1 are relatively new
    .

    This study is based on China's national conditions, and its main research objects are patients with advanced HCC at the first diagnosis, with severe intrahepatic tumor burden, large blood vessel tumor thrombus invasion and extrahepatic oligometastasis, which is closer to the clinical practice in China.
    The patient population also fills the gap in the field of international clinical research
    .

    At the same time, the research team developed and constructed a HAIC-FO efficacy prediction model consisting of 15 genes at the gene level, with a prediction efficiency of 83%.
    The survival benefit of the HAIC-FO effective population identified by the model was significantly improved
    .

    It is suggested that this model becomes the first HAIC-FO efficacy and survival benefit prediction model for advanced HCC, and further validates the gene mutation status of advanced HCC
    .

    Q: What is the guiding significance of this study for the diagnosis and treatment of patients with advanced hepatocellular carcinoma in my country? ▎Professor Ming Zhao: At present, molecularly targeted drug therapy represented by sorafenib and interventional transcatheter arterial chemoembolization (TACE) are often used in advanced HCC patients without surgical indications.
    The results of the FOHAIC-1 study provide All feasible new options have been established, which has laid the foundation for further interventional HAIC-FO combined with immune/targeted therapy, and at the same time constructed a HAIC-FO efficacy prediction model, providing evidence-based medical evidence for these new treatment options
    .

    However, in the face of many optional treatment options, the problem of "how to choose first-line treatment" is prone to occur in the process of clinical practice
    .

    With the recognition and promotion of HAIC-FO therapy in the diagnosis and treatment of HCC patients, for advanced HCC patients with severe intrahepatic tumor burden and large vessel tumor thrombus invasion, further precise patient stratification is required, and standard first-line targeted, In the future, immunodrug therapy and TACE interventional therapy may be combined with HAIC-FO and targeted/immunotherapy through the efficacy prediction model in the future, so as to obtain more tumor downstaging and transformation, and allow patients to obtain greater clinical benefits
    .

    Therefore, when we face more and more diagnosis and treatment options, we should strictly abide by the research results of the team to choose, and implement "precision medicine" in the diagnosis and treatment of advanced HCC patients
    .

    Q: What are the unsolved problems in the clinical diagnosis and treatment of advanced hepatocellular carcinoma? What related research are you and your team still doing? ▎Professor Zhao Ming: At present, there are three main problems in the clinical diagnosis and treatment of advanced HCC patients to be solved
    .

    1.
    HAIC-FO therapy has a damaging effect on liver function, especially for patients with poor liver function and large tumor burden, the effect is obviously not good
    .

    Therefore, how to give them the best therapeutic effect while protecting the liver function of patients is one of the difficult problems to be solved
    .

    2.
    The research team is currently working hard to discover the biomolecular changes of HCC through the established HAIC-FO efficacy prediction model, and further improve the overall treatment efficacy of HCC patients through stratified or individualized treatment
    .

    3.
    Some HCC patients still have disease progression after receiving first-line targeted and immunotherapy.
    How to choose a more effective later-line treatment to improve patient benefit and survival is also a problem to be considered by the research team
    .

    Experts commented that patients with advanced HCC who received HAIC-FO had better clinical efficacy and patient benefit than sorafenib, regardless of whether they had a higher intrahepatic burden
    .

    FOHAIC-1 is based on China's national conditions.
    Its research targets are patients with advanced HCC at the first diagnosis, and with severe intrahepatic tumor burden, large blood vessel tumor thrombus invasion, and extrahepatic oligometastasis.
    Hepatic artery perfusion therapy significantly improves these patients.
    It also provides a new option for the treatment of advanced liver cancer and fills the gap in the field of international clinical research
    .

    The research team developed an exploratory model to predict the efficacy of FOHAIC-1 based on genome sequencing, providing new evidence-based medical evidence for this new treatment option and providing more help for future treatment strategies
    .

        Expert Profile Professor Zhao Ming, Chief Physician, Doctoral Supervisor; Deputy Director of the Department of Minimally Invasive Interventional Therapy, PI Sun Yat-sen University Cancer Prevention Center, South China State Key Laboratory Association: Member of the National Health Commission Capacity Building and Continuing Education Oncology Expert Committee National Member of the Cancer Center Liver Cancer Quality Control Expert Committee Chinese Society of Clinical Oncology (CSCO): Standing member of the Liver Cancer Expert Committee; standing member of the Interventional Professional Committee China Anti-Cancer Association (CACA): Chairman of the Interventional Professional Committee Chemotherapy and Immunology Expert Committee; Interventional Professional Committee Standing Member ; Member of the Professional Committee of Liver Cancer; Chairman of the Professional Committee of Minimally Invasive Interventional Therapy of Guangzhou Anti-Cancer Association; More than 30 papers, including more than 30 SCI papers: correspondence papers including JCO, Gut, Journal of Hepatology, JITC, Liver Cancer, Radiology, etc.
    Participated in: "CSCO Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2018 Edition), (2020 Edition)", "National Health Commission's Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2021)", "ISMIO International HCC Expert Collaboration Group TACE Clinical Practice Consensus (2021)", "Chinese Hepatocellular Carcinoma Transarterial Chemoembolization (TACE) Clinical Practice Guidelines (2021)" References for the development of consensuses in the fields of liver cancer MDT, transformation, and immunity: [1] https://ascopubs.
    org/doi/pdf/10.
    1200/JCO.
    21.
    01963 [2] Park JW, Chen M, Colombo M , et al.
    Global patterns of hepatocellular carcinoma management from diagnosis to death:the BRIDGE study[J].
    Liver Int,2015,35(9):2155-2166.
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.