The new "Consensus of Chinese Experts on Transformation Therapy of Liver Cancer" is released, helping the road to "cure" for liver cancer

*Only for medical professionals to read and refer to my country's first Chinese Expert Consensus on Transformation Therapy for Liver Cancer.
The diagnosis and treatment of liver cancer has entered a new journey.

On May 9, 2021, the "Consensus of Chinese Experts on Translational Therapy of Liver Cancer" (referred to as "Consensus") launched by the Translational Therapy Collaboration Group of the Liver Cancer Committee of the Chinese Anti-Cancer Association and drafted by multidisciplinary experts in the field of liver cancer was held in Shanghai .

Academician Fan Jia of Zhongshan Hospital Affiliated to Fudan University, Professor Qin Shukui of Qinhuai Medical District, General Hospital of Eastern Theater Command of PLA, Professor Cai Jianqiang from Cancer Hospital of Chinese Academy of Medical Sciences, Professor Zhou Jian from Zhongshan Hospital Affiliated to Fudan University, Professor Chen Minshan from Cancer Center of Sun Yat-sen University, Tongji Medicine of Huazhong University of Science and Technology Professor Zhang Bixiang from Tongji Hospital affiliated to the hospital and Professor Sun Huichuan from Zhongshan Hospital affiliated to Fudan University attended and witnessed the official release of China’s first "Consensus of Chinese Experts on Translational Therapy of Liver Cancer" and expressed professional opinions on transformational treatment of liver cancer.

With the rapid development of translational therapy in China, a "consensus" came into being, Academician Fan Jia pointed out: The issuance of the consensus is of great significance for improving the treatment level of liver cancer and improving the overall prognosis of liver cancer patients.

Surgical resection is still the most important means to achieve radical cure and long-term survival.
However, 70%-80% of liver cancer patients in my country are in the middle and advanced stages when they are first diagnosed, and have lost the opportunity for surgery.
The 5-year survival rate is less than 20%.

Transformation therapy can transform the initially unresectable into operable and palliative surgery into radical resection, which can help prolong the recurrence-free survival (RFS) and overall survival (OS) of patients, improve the overall prognosis of liver cancer, and achieve " The ambitious goal of increasing the five-year survival rate of liver cancer patients by 15% by 2030 in the Healthy China 2030 Planning Outline.

 Multidisciplinary collaboration and comprehensive consideration of drug selection to improve the benefits of translational therapy Professor Cai Jianqiang said: Liver cancer is not only a local problem, it is actually a systemic problem.

Because tumor cells can evade immune surveillance, they may hide after entering the bloodstream and relapse later.

For patients with successful surgical resection after conversion therapy, systemic treatment is still needed.

In addition, in China, 80% or more of liver cancer patients are infected with hepatitis B virus.
The multicentric origin of cancer foci under the background of hepatitis and liver cirrhosis also requires systemic treatment assistance after liver cancer resection.

In general, patients with successful conversion therapy must undergo systemic drug support after surgical resection.

However, systemic treatment after conversion therapy surgery is not unlimited.
When to stop the drug and when to achieve complete remission, it is necessary to participate in the decision of multiple disciplines.

Of course, individualized treatment is also very important.
Clinicians need to strengthen patient education to encourage patients to pay attention to follow-up visits and follow-up visits, and to communicate and check with doctors on a regular basis in order to assess their condition in real time and ensure a longer survival and quality of life for patients.

 Professor Chen Minshan pointed out: Although surgical treatment is the best way to treat liver cancer, single-disciplinary treatment still has certain limits.

On the one hand, about 80% of liver cancer patients have lost the opportunity for surgery when they are diagnosed, and even those who can be surgically removed have a certain recurrence rate.

Therefore, the treatment of liver cancer cannot be solved by relying on a single discipline.
Instead, it needs to be combined with interventional, internal medicine, radiotherapy and other disciplines to participate in comprehensive treatment.

In addition, the purpose of clinical conversion therapy is not purely for conversion therapy, because not all liver cancers can be treated with conversion therapy.
The real purpose is to improve the survival rate of liver cancer.

Increasing the survival rate of liver cancer patients cannot be accomplished by a single discipline.
The entire conversion therapy process requires the participation of a multidisciplinary team, including the selection of cases and the selection of treatment methods, which require multidisciplinary discussions to select the most suitable patients.
Method for conversion therapy.

 Professor Zhou Jian, the host of the press conference, said: Conversion therapy means that patients with liver cancer who cannot be surgically removed will become surgically resectable after treatment, in order to obtain the opportunity of radical resection and achieve long-term survival.

At present, there are many conversion treatment options, including systemic treatment, local treatment, etc.
, which can transform unresectable patients into resectable patients.

In the selection of translational treatment options, clinicians need to comprehensively consider the following three factors to obtain a better conversion treatment effect: Tumor treatment effect: whether the selected conversion treatment plan can shrink the tumor and obtain partial/complete remission Or at least to keep the tumor in a stable state without metastasis.
If the selected program does not benefit from the tumor, it will lose its therapeutic significance.

Impact on liver function: Will it affect the patient's liver function and platelets while anti-tumor treatment? Different anti-cancer drugs have different side effects.
Although some anti-cancer drugs can shrink tumors, the platelets are lowered and the transaminase is increased.
Liver function is impaired, and surgery cannot be performed.

Therefore, it is necessary to pay attention to the control or prevention of side effects when choosing a plan.

The patient's general condition: Some patients have reduced their tumors after using the drug, but they cannot eat, are malnourished, and are in poor general condition.
The patient is also inoperable, and the treatment is not worth promoting.

In the new era of targeted immunity, new ideas for the transformation of liver cancer have been explored.
In recent years, new treatments and drugs have continued to emerge, providing more possibilities for the realization of liver cancer downgrading, which is conducive to the realization of translational therapy and the creation of surgical opportunities.

Targeted therapy and immunotherapy have synergistic and complementary effects in the mechanism of action, and their combined use shows a "1+1>2" synergistic result with half the effort, providing a good idea for transformational therapy of liver cancer.

 Professor Fan Jia pointed out: TKI+ immunotherapy can effectively reduce the focus of the disease, and even some patients with metastases can be effectively downgraded, get surgery or other treatment opportunities, and achieve long-term survival and improve the quality of life.

 Professor Zhang Bixiang said: The application of immune combined targeted therapy in translational therapy is the biggest progress made in the field of liver cancer treatment in recent years.
At present, it is mainly based on the combination of anti-angiogenesis drugs and PD-1 inhibitors.

However, the current research sample size is not particularly large, and it needs to be done better on the basis of a unified consensus in the future.

Prospects for the future development of translational therapy Professor Fan Jia said: Targeted therapy, immunotherapy, cell therapy, gene therapy or biological therapy are all explorations that can promote the transformation of liver cancer from large to small, from more to less, from late to mid or early field.

In addition, the combination of treatment methods is also a major direction for future exploration.
The combined treatment may achieve the therapeutic effect of 1+1>2, 1+1+1>3, which makes the patients with liver cancer change from large to small, from more to less, which is a follow-up Treatment provides conditions and opportunities.

 Professor Qin Shukui said: Given that most Chinese liver cancer patients have hepatitis B virus infection, how to control the hepatitis B virus and basic liver diseases will become an important issue.

Secondly, due to the rapid progress of liver cancer, most patients have lost the opportunity of surgery when they are diagnosed.
How can these patients be downgraded/downgraded through local and systemic treatments and converted into surgical treatments, while reducing the recurrence rate after surgery and improving long-term survival? Rate is also an important research direction.

 Professor Sun Huichuan pointed out: The release of this consensus has brought the treatment of liver cancer into a new journey.
At present, we only know that this road can be done, but how to take this road well? How to go more efficiently? There are still many problems to be solved.

For example, after the successful transformation, the tumor shrinks, does it need to be removed? There are many conversion therapy programs available, how to choose the most effective conversion therapy program? Are there markers before conversion therapy to determine which patients have good conversion therapy effects, so as to improve the success rate of conversion therapy? How to treat patients who fail to convert? How to arrange troops reasonably, transform the treatment and protect the liver at the same time? Such issues require further research and exploration.

The successful release of the "Consensus of Chinese Experts on Transformation Therapy of Liver Cancer" will help transform the treatment of liver cancer to mature and standardize, and bring more benefits to patients with advanced liver cancer.
I believe that with the continuous development of research and the continuous emergence of research results, consensus Will be revised again to better guide clinical practice.