Professor Chen Minshan: Annual inventory of progress in liver cancer treatment in 2020

Professor Chen Minshan, Chief Physician, Doctoral Mentor.
is now director of liver surgery at Sun Yat-sen University Cancer Prevention and Control Center and director of the Liver Cancer Research Institute at Sun Yat-sen University.
is also a member of the Chairman of the Liver Cancer Professional Committee of the Chinese Anti-Cancer Association, a Member of the Professional Committee of the Chinese Physicians Association, a Member of the Chairman of the Liver Cancer Branch of the Guangdong Medical Association, an Honorary Chairman of the Liver Cancer Professional Committee of the Guangdong Anti-Cancer Association, and a visiting professor of surgery at Chinese University of Hong Kong.
has been engaged in the clinical and research work of liver cancer for 30 years, mainly in clinical field, familiar with and master the various treatment methods of liver cancer, and actively promote the multidisciplinary comprehensive treatment of liver cancer.
published a total of 162 liver cancer research papers, for 6 consecutive years in Elsevier China's list of highly cited scholars, a total of 6 clinical research papers by the U.S. NCCN guidelines "liver cancer" section cited.
"Multidisciplinary Treatment Strategy and Optimization and Application of Liver Cancer" conducted by The Ministry of Science and Technology won the first prize of science and technology in Guangdong Province in 2016.
was named the first "Sun Yat-sen University Doctor" in 2014 and the first "Guangdong Good Doctor" in 2017.
The annual inventory of the progress of liver cancer treatment in 2020, Hu Dandan, Chen Minshan Zhongshan University Cancer Prevention and Control Center liver surgery (summary) China's hepatitis B vaccination has been fully implemented for nearly 30 years, the infection rate of hepatitis B virus has decreased, but the incidence of liver cancer and mortality rate is still high.
present, the treatment mode of liver cancer has changed from a single local treatment to a multidisciplinary comprehensive treatment with organic combination including surgery, ablation, intervention, targeting and immunotherapy.
in the field of drug treatment for liver cancer compared to local treatment, the field of liver cancer has made remarkable progress in 2020.
this paper will systematically summarize the progress of liver cancer research this year from both local treatment and systemic treatment.
key words: hepatocellular carcinoma, multidisciplinary comprehensive treatment, targeted treatment, immunotherapy in the full implementation of hepatitis B vaccination nearly 30 years, China is still a high incidence of liver cancer.
recent years, the treatment of liver cancer has changed from a single local treatment to a multidisciplinary comprehensive treatment, that is, local treatment combined with systemic therapy model, and brought significant oncology benefits to patients.
2020, the world experienced a rare outbreak of neo-crown pneumonia, medical practitioners in the research of new crown pneumonia, but still in their respective established research areas have achieved remarkable results.
important research progress in the treatment of liver cancer.
this paper to this extraordinary year of liver cancer clinical treatment research areas to carry out a summary inventory.
First, local treatment 1.1 surgical excision / ablation treatment / radiation therapy surgical excision is currently the most commonly used treatment of liver cancer, through multidisciplinary model to further improve the effect of liver excision and local ablation treatment has been a hot topic of clinical research.
This year's major international conferences published several advances in research on complementary and conversion therapy, including a new study of complementary therapy published at the 2020 annual meeting of the American Society of Clinical Oncology (ASCO) on 30 patients with liver cancer that could be removed at the beginning of the treatment, using three cycles of Navuliyu monotherapy or navu before surgery. The treatment of hepatocellular carcinoma (HCC) with a total pathological remission rate of 24% after surgical excision (3 cases in the joint group, 2 cases in the single drug group), and 16% in the main pathological remission rate (necrosis effect, 2 cases in the joint group, 1 case in the single drug group), did not lead to the occurrence of toxicity delayed or cancelled by surgery.
40% pathological remission rate of the study as a whole laid the foundation for immunotherapy in the resectionable HCC, which was widely concerned.
more notable are several studies of conversion therapy: a study of 60 non-removable HCC patients (2 patients with BCLC-A, 13 cases of stage B and 45 cases of stage C) was published at asCO's annual meeting, by tyrosine kinase inhibitor After the treatment of the combined programmed death protein-1 (programmed death-1, PD-1) inhibitors, 9 patients (18.3%) were surgically removed from HCC, of which 6 patients were confirmed to be in complete pathological remission after surgery.
the study offers hope for long-term survival benefits for patients with advanced liver cancer.
in addition, the ESMO ASIA conference released another study: 35 non-removable HCC patients were treated with TKI combined PD-1 inhibitors, of which 30 patients were accompanied by a venous venous thrombosis, 2 patients were accompanied by liver venous thrombosis, 3 patients were both;
results showed a successful radiology-based conversion rate of 42.4% (14/33).
can then be surgically removed with R0, and no serious complications or postoperative deaths have been observed.
the medium follow-up time was 7.2 months, the medium recurrence free survival( RFS) time and the medium total survival (overall survival, OS) time were 3.9 months and 6.5 months, respectively.
the above two studies suggest that the combined treatment of TKI and PD-1 inhibitors is a safe and effective option for HCC conversion therapy in the middle and late stages.
long time, whether liver cell carcinoma needs complementary treatment after surgery is also a hot topic of research.
june this year, a multi-center study explored the complementary therapeutic effects of postoperative iodine (131I) methoxidium resistance in the treatment of liver cancer.
study included 156 HCC patients with CD147 expression, and patients in the treatment group were given 1 hepatic arterial injection of iodine (131I) methoximonas at 4 to 6 weeks after surgery, resulting in a significant 5-year RFS time compared to the blank control group in patients in the treatment group. The promotion (43.4%:21.7%, P-0.0031) suggests that the auxiliary program can improve the prognosis of patients, and also suggests that liver cancer patients should be sub-grouped according to biomarkers for more accurate programming and management.
also reported the results of a multi-center, forward-looking cohort study for postoperative HCC patient-assisted therapy (LANCE study) at this year's ANNUAL MEETING of ASCO.
The study included 90 postoperative patients with a high risk of recurrence (large blood vessel or bile duct rupture or infestion of adjacent organs/II. level microvascular aggression combined with any of the following: number of tumors ≥3, maximum tumor diameter ≥8cm, tumor edge unclear or incomplete envelope).
results showed that the medium disease-free survival (disease free survival, DFS) in patients in the combined TACE group was significantly longer than in the simple TACE group (12.0 months: 8.0 months; HR-0.5, P-0.0359).
suggests that the complementary therapy of lenphatinistinist is effective and safe, which can prolong the progression-free survival of HCC patients with high risk of recurrence after surgery.
results of another study that also used intervention as an afteroperative aid treatment were also of concern.
the study was a forward-looking, open-label, Phase III. phase, and randomized controlled trial.
patients in the
group were 127 HCC patients with postoperative pathological tips with microvascular aggression, randomly included in the treatment group and follow-up group, and the patients in the treatment group received 2 courses of FOLFOX course liver arterial perfusion chemotherapy (hepatic arterial infusion chemotherapy, HAIC).
results showed that the OS rates of 100.0%, 97.7% and 97.7% were 100.0%, 97.7% and 78.5% in the follow-up group, respectively, in the treatment group of 6, 12 and 18 months.
DFS rates were 84.7%, 61.8% and 58.7% for patients in the treatment group for 6, 12 and 18 months respectively, and 62.9%, 48.1% and 38.6% for follow-up groups, respectively.
the results of the study suggest that post-excision-assisted HAIC therapy can improve OS time and DFS time in HCC patients with microvascular aggression.
advances in radiotherapy technology have made it emerging in the treatment of liver cancer, but its scope of application still needs to be further explored.
a multi-center study in Asia this year compared the efficacy of stereotactic radiotherapy (SBRT) and radiofrequency ablation (RFA) and found that patients in the SBRT and RFA groups had accumulated local recurrence rates over a three-year longer. 21.2% and 27.9% respectively, where SBRT has better local control rate for tumors that are large, subsized, and relapse after TACE, suggesting that SBRT may be an effective alternative to RFA.
, radiotherapy also has certain advantages in the treatment of venous venous thrombosis.
studies have reported that for liver cancers that can be completely removed from the combined venous venous thrombosis, preoperative new assisted radiotherapy can improve the prognosis of patients.
in the current clinical practice, radiotherapy is still not suitable for surgical excision and radio frequency ablation to treat patients with small liver cancer, but also can be used in combination with other treatment methods.
1.2 interventional treatment of TACE is one of the most commonly used treatment methods for insecremental liver cancer that cannot be operated on, but it is not satisfactory in improving the prognosis of patients.
improved HAIC has shown better therapeutic potential.
In a 2019 study published in JAMA Oncology, a team of professors at Sun Yat-sen University's Center for Oncology and Prevention compared the application of HAIC and Solafini in mid- to late-stage liver cancer, it was concluded that the combined SORAF treatment compared to sorafini monotherapy significantly extended the survival time of patients (13.37 months: 7.13 months, P <0.001).
this year's ESMO conference, the team presented a randomized, multi-center RCT study.
In this trial, 315 adult (≥18 years old) patients with non-removable HCC, a maximum diameter of ≥7 cm, no large vascular invasion or liver metastasis were treated at random at 1:1 with HAIC (n=159) or TACE (n=156).
results showed that the mid-OS time of patients receiving HAIC was higher than that of the TACE group (23.1 months: 16.07 months).
the objective remission rate (objective response rate, ORR) of patients in the HAIC group was higher than that of the TACE group (RECIST: 45.9%:17.9%, P<0.001; mRECIST: 48.4%:32.7%, P 0.004), mPFS time is longer (9.63 months: 5.40 months, P.lt;0.001), and there are more cases of conversion surgery (23.8 percent: 11.5 percent, P.004).
the study confirmed that in patients with non-excisible HCC, HAIC showed surprising results in terms of tumor effectiveness and conversion removal.
same time, Professor Shi Ming reviewed the effectiveness and safety of the treatment of 157 patients with advanced liver cancer with a single drug called lenphatinib and Ripley monoanti and HAIC in another wall-journal study at the ESMO Annual Meeting.
results showed that patients in the triple treatment group showed longer PFS time (11.1 months: 5.1 months, P-lt;0.001); longer OS time (not up to: 11 months, P-lt;0.001); higher DCR rate (RECIST or mRECIST: 90.1%: 72.1%, P -0. .005); and the higher ORR (RECIST: 59.2%:9.3%, P.lt;0.001; mRECIST: 67.6%: 16.3%, P.lt;0.001), showed that HAIC combined lenphatini and Tripli single resistance significantly improved the efficacy of patients with advanced liver cancer.
above study initially showed the unprecedented and satisfactory role of HAIC in middle and late stage liver cancer.
II, systemic treatment 2.1 targeted treatment in recent years, targeted drug treatment of liver cancer has achieved a number of breakthroughs, liver cancer targeted treatment drugs are no longer soraphini.
First, Rigoffinist established the status of second-line therapy after the progress of soraphinist, and then, after that, the REFLECT study determined the position of lenvatinini in first-line treatment of liver cancer, becoming the second effective HCC drug after soraphinist.
oral report to this year's ASCO annual meeting, there were two studies of single-use targeted drugs.
a randomized, placebo-controlled, double-blind phase III study for the second-line treatment of patients with advanced liver cancer in China.
patients were randomly divided into the apatinib group (n=261) and the placebo group (n=132).
results showed that the efficacy of the apatinib group was significantly better than that of the placebo group (mOS: 8.7 months: 6.8 months, HR:0.785, P=0.0476; PFS: 4.5 months: 1.9 months, HR:0.471, P˂0.0001; ORR: 10.7%:1.5%).
concluded that apatinin can significantly extend the OS time and PFS time of advanced HCC patients with first-line drug resistance, and that the patient's tolerance is good and safe and controllable.
the other was the open label, randomized, multi-center II./III. phase trial of the late-stage HCC treatment of Donaforinie Piso laffinie.
668 patients were included in the group, which was randomly grouped at 1:1.
results showed that patients in the Donovanic group received longer OS time (mOS: 12.0 months: 10.1 months, HR=0.839, P=0.0446) compared to the Sora noni group, however