Professor Yang Tian: The 2020 edition of cSCO Primary Liver Cancer Diagnosis and Treatment Guidelines updates the key points of interpretation, focusing on immuno-targeted combination therapy.

!---- The Chinese Society of Clinical Oncology (CSCO) held a press conference in Shanghai to officially release the 2020 edition of the CSCO Primary Liver Cancer Diagnosis and Treatment Guide (hereinafter referred to as the Guide).this is the latest version of cSCO's release following the release of the previous edition in 2018.specially invited Professor Yang Tian, who was to the Third Affiliated Hospital of naval medical university, to interpret the latest edition of the guidelines and conduct an exclusive interview on the progress and clinical application of immuno-targeted treatment in liver cancer. Yang Tian, Deputy Director of Physician, Associate Professor, Master's Tutor, Deputy Director of Hepatobiliary Surgery, Oriental Hepatobiliary Surgery Hospital, Shanghai Naval Medical University, Senior Clinical Visiting Scholar of Organ Transplant Center and Liver Surgery, Mount Sinai Hospital, New York, USA, Member of the Academic Committee of the International Association of Hepatobiliary Pancreatic (IHPBA), Member of the Asia-Pacific Hepatobiliary Pancreatic Association (A-PHPBA) Academic Committee, International Hepatobiliate Association General Secretary of the Chinese Branch of the Bile Pancreatic Association (CCIHPBA), member of the Youth Committee of the Chinese Society of Clinical Oncology (CSCO), member of the Organ Donation Professional Committee of the Organ Transplant Physicians Branch of the Chinese Physicians Association, member of the Professional Information Communication and Education Work Committee of the Surgeons' Branch of the Chinese Physicians Association, member of the Simulation Medicine Branch of the National Association of Health Industry EnterpriseS, and member of the Chinese Digestive Surgery Group of The Imritor.the 2020 edition of the CSCO Primary Liver Cancer Diagnosis and Treatment Guidelines updated the main points of the last two years, the results of clinical research on liver cancer highlighted, the field of especially internal medicine treatment more rapid development.2020 edition of the CSCO Primary Liver Cancer Diagnosis and Treatment Guide also keeps pace with the times, absorbs the latest evidence-based medical progress, updates innovative treatment concepts, in order to better guide the clinical practice of doctors and maximize patient benefits.liver cancer is a disease that requires multidisciplinary participation in treatment, multidisciplinary diagnosis and treatment model (MDT) is currently an internationally recognized model of diagnosis and treatment in the field of cancer, can effectively help liver cancer patients to choose the most suitable treatment plan, to achieve personalized comprehensive treatment, which is one of the highlights of the update of the guide.in the field of surgical treatment, minimally invasive treatment and conversion excision have attracted much attention.celiac liver removal is recommended for small liver removal smaller than three stages and liver edge tumors.recommended by class III experts for phase IIb-III liver cancer, new preoperative auxiliary therapy (induced treatment) to tumor reduction and then excision, with a view to reducing the recurrence rate after surgery and prolonging the patient's survival time.in the systematic treatment of liver cancer, in recent years, targeted drugs and immunotherapy drugs have sprung up, especially in combination with immunotherapy has attracted much attention.the Guide has added a number of targeted, immuno-drug and combination treatment options in the field of first-line and second-line treatment, among which attheili zuma suprem anti-bisco-immune combination therapy (T-A) based on IMbrave150 has become a first-line treatment Grade I expert recommendation (1A evidence)., the new guidelines also adjust immunotherapy in the field of postoperative complementary therapy, have also had corresponding indications and updates in the field of intervention, radiotherapy and ablation, and have been revised in this update to the antiviral treatment of hepatitis-related liver cancer.brave man's research - IMbrave150 study deserved lying for 1A evidence in the new edition of the Guide, advanced liver cancer first-line and second-line system treatment updates are larger, there are three immuno-combined targeted treatment options written to the first-line treatment, including atirezumab anti-combination bevalu zuma The "T-A" scheme, the Revenatini joint Paboli bead monotag, apatierini united Karelli bead monobden, the latter two options are recommended at level III, and the "T-A" scheme is the highest level of I recommendation.CSCO Guidelines have strict requirements for the recommendation of evidence levels, and based on randomized controlled studies (RCTs), especially global, multi-center, and rigorously designed Phase III clinical trials, the recommendation level is more recognized.'s recognition of evidence-based medical evidence follows a rule of whether it is published in a very advanced medical journal and is subject to the approval and approval of international experts.the IMbrave150 study, published in the New England Journal of Medicine, is a global multicenter Phase III clinical study that meets the recommended level I."IMbrave", I prefer to read "I'm brave", which is a very brave study. the study used double endpoints, total survival time (OS) and progression-free survival (PFS) as the main endpoints of the study. final results were also very surprising, with both main destinations reaching pre-set values and positive results. in the global population, the median OS in the atlizumab and beifazumab groups was significantly longer than that of the Sorafeni group, reducing the risk of death by 42% (HR 0.58) for those who did not reach vs 13.2 months (P.0006); in the Chinese group, the median OS was not reached and 11.4 months, respectively, the risk of death decreased by 56%, and the median PFS was 5.7 months and 3.2 months, respectively, the risk of disease progression or death decreased by 40%. ORRs evaluated according to mRECIST standards were 30% and 8%, respectively. is based on such excellent research results that the "T-A" scheme is recommended as an I-level in the new Guide. effective and safe, "T-A" program 1 s1 sgt;2 in clinical work, for the late non-removable liver cancer system treatment of the joint option, I prefer the treatment of 1 sgt; 2 treatment. the combination of immune and immunodrugs, or the combination of immune and targeted drugs, and even the combination of immunoandological and chemotherapy drugs related research is very many, in clinical practice how to choose, I mainly consider the following points: first, the patient's general physical condition, such as whether the patient can tolerate, how physical lying, liver function, can tolerate the combination of different drugs. second to consider the side effects of the drug. it is well known that targeted drugs such as solafenib and rifestinib have relatively large side effects, while immunotherapy drugs are relatively safe. when using combination therapy, the toxic side effects of combination drugs need to be fully considered, especially serious side effects above level 3. and the "T-A" scheme, based on its findings, showed that the overall rate of side effects was lower, even smaller than the single drug solafenin, and was a safer combination. immunological combination targeted treatment leads the new journey of liver cancer treatment because of the high degree of malignancy of liver cancer, so the treatment is extremely complex, the need for personalized comprehensive treatment. because the clinical treatment of liver cancer patients are mostly advanced, tumor slots and larger lumps, mostly accompanied by vascular aggression, is a high-risk recurrence of liver cancer groups. in the treatment of advanced liver cancer, I personally prefer intervention and immunotherapy combined. if the patient can tolerate, can be combined with targeted treatment, i.e. local therapy plus systemic treatment. combination of immunotherapy and targeted therapy or can be used for postoperative prophylactic assisted therapy in high-risk patients. recently, we are conducting a follow-up study of postoperative biomarkers, the preliminary results show that the first follow-up after surgery when the AFP did not achieve a full response of patients, about 90% after 2 years of follow-up time can appear re-incidence lesions, indicating that there are still residual cancer cells after root-based liver removal. Although there is currently no generally recognized anti-recurrence treatment plan at home and abroad, including postoperative preventive intervention, the combination of immunization and targeted drugs in patients with better postoperative recovery in advance intervention has observed some efficacy. there are a lot of relevant RCT studies, including the multi-center, random, open-label Phase III study- IMbrave 050 study that explores the efficacy of "T-A" protocol-assisted therapy in patients with high risk of recurrence after surgical excision or ablation. if the study were positive, it would make a huge difference to clinical practice. on new preoperative complementary therapies, this year's ASCO conference also included a study from the MD Anderson Cancer Center in the United States to explore the safety and efficacy of targeted and immunotherapy drugs combined with preoperative drugs. in The Phase II study, more than 20% of patients achieved pathology complete remission (pCR), which is a very good area to explore. I am personally cautious about new complementary treatments for liver cancer. immunotherapy has fewer side effects and higher safety than targeted drugs, and it is also a good direction to try immuno-monodrug therapy without affecting surgery. Linda Source: Tumor Information !-- End of Content Presentation -- !-- Determine Signed-up End-