Prof. Zhai Baocai: The survival period has doubled, and the "T-A" immunotherapy has promoted a leap forward in the systematic treatment of advanced liver cancer

Liver cancer is the sixth most common cancer in the world and the third leading cause of cancer death, according to the World Health Organization's International Agency for Research on Cancer (IARC) 2020.
most Chinese liver cancer patients are in the middle and late stages when they are first diagnosed, with low survival rates and poor prognosis.
in the HCC treatment changes, surgery, radiotherapy, intervention, chemotherapy, targeting, to today's immunotherapy and immunotherapy, liver cancer treatment methods gradually rich and mature.
The world's only first-line immunologic combination therapy approved for non-excision of hepatocellular carcinoma treatment at present, Atiliju single anti-combination beva bead monoantimmune (the "T-A" program) published the latest results of the study, after the "T-A" treatment of patients with a total survival of 19.2 months, of which the Chinese sub-group of patients with a medium total survival of 24.0 months, bringing new hope for patients with advanced liver cancer.
Against this background, we had the privilege of inviting Professor Yu Baocai, Director of the Department of Hepatocholine Pancreatic Surgery at Peking University Cancer Hospital, to listen to his professional insights on the current state of liver cancer diagnosis and treatment in China, the interpretation of the results of IMbrave150 research, and the prospects for the application of the "T-A" immunotherapy program.
I. Efficiency from 3% to 30%, immunotherapy makes a leap forward in the systematic treatment of liver cancer, talking about the systematic treatment of liver cancer, from a haze a little bit to see the light of day.
until 2007, the treatment of liver cancer was still in surgical and local treatment.
was not until the launch of Solaphini in 2007 that systematic treatment for liver cancer was launched.
the effectiveness of sorafine is only 3% to 4%, which can only extend the survival of some patients.
decades later, lenphatinistinist was approved in 2018 for its non-inferior results, becoming a first-line treatment for liver cancer, changing the situation of single-drug treatment in Solafini for a decade, but the effective rate of lenvatinini is also not high, only a dozen percent.
2020, the ASCO Conference published the results of the esoteric effects of donnaphini, making the current first-line targeting drugs for liver cancer soraphini, lenvatini, donnaphini "three-legged."
the overall efficiency of targeted drugs is still low, liver cancer patients still face great difficulties in prognosis.
in an era of rising immunotherapy, researchers are beginning to come up with the idea of combined drug use.
, research around targeted drugs combined with immunologic drugs continues to sing.
Under the constant collision, there are three main schemes in which the application of joint drug use has made good progress, including the "T-A" scheme of TaiSanqi combined beval beval bead mono-resistance, the "double Ai combination" of Karelli-Pearl single-anti-combination Apatini, and the "cola combination" of Paboli-Pearl single-anti-combined lenvatini.
to date, immunotherapy has been proven to have significant efficacy, compared with the past single-targeted treatment, immunotherapy combined target therapy has significantly improved the effective rate than single-use lenvatinib, the efficiency of about 30%.
from 3% in the past to 30% today, there has been a leap forward in the systematic treatment of liver cancer.
II, "T-A" program completely changed the pattern of first-line treatment of advanced liver cancer IMbrave150 study total survival of the latest results released, the results confirmed that "T-A" can bring patients a double improvement in survival and quality of life, is a major advance in the treatment of hepatocellular carcinoma.
The combination treatment plan of "T-A" has completely changed the pattern of first-line treatment of advanced liver cancer, and in this context, the overall treatment strategy of liver cancer should also be re-examined, and the combination therapy of T-A has benefited different patients with advanced liver cancer.
in patients with removable liver cancer, up to 50%-70% of patients still relapse after surgery, which can seriously affect the prognosis.
for high-recurrence patients who are partially partially resection, a preoperative "T-A" option can be used to screen out which parts of the patient are better suited for surgery and get the best survival benefit.
change the overall treatment order, treatment strategy can have a certain reversal of treatment results.
for patients with non-excisible liver cancer, on the one hand, systemic treatment can achieve an effective rate of about 30%, and make the non-excisible liver cancer gradually transformed into excisible.
at a 30% effective rate, about 10% to 15% of patients are able to convert to removable liver cancer and benefit greatly from survival.
On the other hand, although about 80% of patients still cannot be removed after the treatment of "T-A", compared with the past survival of about 12 months of Soraphini, the "T-A" program in China subgroup can be raised to a 24-month mid-life, has been a leap forward.
for liver cancer patients, in addition to "living long", "living well" is also very important.
the results of the Global High Quality Patient Report Outcome (PRO) study by IMbrave150 show that the combination therapy of "T-A" has greatly improved the quality of life, body function and role function of patients.
7.6 months (medium TTD, 11.2 months vs. 3) of the "T-A" combination therapy can delay the deterioration of the quality of life (QoL) reported by patients compared to Solapini therapy .6 months), body function TTD time (median TTD, 13.1 months vs 4.9 months), and role function TTD time (median TTD, 9.1 months vs 3.6 months).
patients reported a nearly threefold increase in quality of life, which also means that for patients with liver cancer with poor liver function and weaker bodies, the tolerance of the "T-A" is better, bringing greater likelihood and confidence for the patient to complete the overall treatment.
III, "T-A" combination therapy for conversion excision to provide a new direction of advanced liver cancer patients have generally lost the opportunity to operate, but "conversion excision" can make patients with advanced liver cancer recurrence and long-term prognosis effectively improved.
so-called transformation, means that the routine can not be cut, through some means, let it become removable.
transformation includes both surgical transformation and internal medicine transformation.
surgical transformation: a person's liver volume needs to be more than 30% to survive, and patients with cirrhosis need even the remaining 40%.
If liver cancer patients need the remaining 40%, but the lesions need to be removed 65% of the liver, this time will generally use surgical means to make the left liver larger, liver regeneration becomes larger, normal liver tissue accounted for the entire liver volume of the proportion increased, it can be successfully removed, this is surgical conversion excision.
internal medicine transformation: refers to the systemic treatment of the original large non-removable tumor after treatment to reduce, so that the size of the excision becomes smaller.
past clinical cases have proved that if the treatment is effective, after systematic treatment, not only make the small lesions around the liver disappear, tumor necrosis, but also can make the recurrence rate after the lesions removed significantly reduced.
, the first line of choice for conversion excision should be internal medicine transformation, followed by surgical transformation.
and the emergence of "T-A" combination therapies makes conversion therapy more likely.
generally speaking, the process of conversion excision requires three to four months of systematic treatment, while in the past, due to the high side effects of soravoini, a large number of patients were unable to take the drug in sufficient doses on time.
the toxic side effects of the "T-A" combination therapy are small, tolerance is good, and patients are more likely to complete the entire course of treatment, making it more likely that they will be successful.
"T-A" combination therapy can transform 12%-15% of liver cancer patients from non-removable to removable, even in patients who have not been successful in conversion, after "T-A" treatment can have a significant survival benefits, extended by 2 years of survival.
4. Immune combination therapy will be more widely used in the future in view of the bright eye achievements of the "T-A" combination therapy in the IMbrave150 study, immuno combination therapy plays an important role in the diagnosis and treatment model of liver cancer, and perhaps the immuno combination target reassory surgery or HAIC (hepatic arterial perfusion chemotherapy) will also be the future direction.
Relative to HAIC, TACE (hepatic arterial chemotherapy embolism) is one of the more common treatment methods, TACE hepatic artery chemotherapy embolism is a local treatment by chemotherapy embolism, although widely used, but the effective rate of TACE treatment is 20%, and mainly for patients with tumor size <5cm, for patients with large liver cancer TACE efficiency of only 10%.
HAIC is a continuous perfusion chemotherapy of the hepatic arteries that is much more effective in principle than TACE therapy.
To this day, the effective rate of about 30% of "T-A" has been a very good result, Professor Zhai Baocai believes that the future "T-A-HAIC" triple program will be a new direction, its ORR (objective mitigation rate) will also be raised to more than 40%.
the future, immunotherapy will be more accurate and effective in clinical applications.
the current difficult problems such as the treatment needs of patients with liver cancer, the clear effective population of immunotherapy, and changes in the micro-environment of tumors may also be solved.
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