Topic Written Talk｜Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (6) ——Progress in systemic drug therapy for recurrence or metastasis of advanced gastric cancer (2)

Author: Zhao Changlin, Xinhua Hospital, Dalian University, Xu Huimian, First Affiliated Hospital of China Medical University Preface The recurrence rate of advanced gastric cancer after surgery is as high as 50% to 70%; the five-year survival rate for recurrence or metastasis of advanced gastric cancer is less than 10%
.

The treatment strategy for recurrent or metastatic gastric cancer is a comprehensive treatment based on systemic drug therapy.
After the failure of the first-line treatment of gastric cancer, especially for patients with primary drug resistance, the options for subsequent treatments and treatment options are very limited
.

So far, there is no standard plan for the second-line treatment of advanced gastric cancer recurrence or advanced gastric cancer in China
.

This article combines the new version of the gastric cancer guidelines and the high-level evidence of clinical studies on advanced gastric cancer at home and abroad in recent years, focusing on the comprehensive treatment of advanced gastric cancer recurrence or metastasis (systemic drug therapy: chemical drugs, molecular targeted drugs, immunotherapeutic drugs single and combined Second and third-line treatment of medication), and issues to be considered in the clinical practice of second-line or third-line treatment
.

Single distant metastasis (liver metastasis, lung metastasis, ovarian metastasis, peritoneal metastasis) gastric cancer is discussed in another article
.

1.
Issues to be considered in the clinical practice of second-line or third-line treatment of advanced gastric cancer (1) Using histological or hematological specimens, including re-biopathological examination or high-throughput sequencing/next-generation sequencing (NGS) Screening molecular markers with multiple detection methods, understanding the expression status of HER2, MSI-H/dMMR, PD-L1, and tumor mutation burden (TMB) molecular markers; (2) Fully understanding the distribution and scope of the patient’s tumor burden, and complications risk (obstruction, perforation, bleeding, etc.
), and other local treatment may be used
.

Carefully screen second and third-line gastric cancer patients with large tumor burden; (3) the efficacy and adverse reactions and drug resistance of previous drug treatments; (4) nutrition and the Eastern Cooperative Oncology Group (ECOG) activity status (PS) score; ( 5) Age, underlying diseases; (6) The willingness of patients and their families to treat and socio-economic factors, to comprehensively measure the interests of patients
.

1.
2 Second-line treatment: immunotherapy, chemotherapy, and targeted drug combination chemotherapy.
In recent years, second-line chemotherapy for gastric cancer has also been continuously explored, but the choice of drugs for second-line treatment is very limited
.

In clinical practice, chemotherapy is still the cornerstone of the second-line treatment of advanced gastric cancer
.

For patients with an ECOG PS score of 0 to 1, single-agent chemotherapy can bring survival benefits.
For patients with an ECOG PS score of 2, chemotherapy and dual-agent combination chemotherapy are still lacking basis
.

2020 version of CSCO gastric cancer guidelines update: second-line treatment increases albumin-bound paclitaxel single-agent chemotherapy, level II recommendation (class 1B evidence)
.

The third-line treatment increases nivolumab as a single agent, level I recommendation (1A evidence) and pembrolizumab as a single agent for patients with advanced gastric cancer with PD-L1 CPS>1, level II recommendation (1B evidence)
.

The third-line treatment deletes the single-agent chemotherapy in the original level II recommendation (3 types of evidence)
.

ESMO gastric cancer guidelines recommend different treatment options based on the patient’s ECOG PS score for the second-line treatment of advanced gastric cancer recurrence or advanced metastatic gastric cancer
.

Patients with an ECOG PS score of 0 to 1 can consider paclitaxel combined with ramucirumab; patients with an ECOG PS score of 0 to 2 can consider ramucirumab as a single agent or irinoteb as a single agent or paclitaxel as a single agent; ECOG PS 2 to 4 Of patients are given the best supportive care
.

With the accumulation of evidence-based evidence of immunotherapy in advanced gastric cancer recurrence or advanced gastric cancer, authoritative guidelines at home and abroad such as ESMO and CSCO have recommended immunotherapy as the third-line treatment for advanced gastric cancer recurrence or advanced gastric cancer
.

However, the effective rate of third-line immunotherapy is not high, and the progression-free survival (PFS) is short, which is far from meeting the needs of clinical treatment for patients with advanced gastric cancer recurrence or advanced gastric cancer
.

In recent years, the development of immunotherapy in the field of gastric cancer has continued to advance.
The status of immune checkpoint inhibitors in the third-line treatment of advanced gastric cancer has been confirmed, and the second-line treatment model is also being explored
.

In 2019, ASCO announced a multi-cancer, multi-center, open-label, phase II clinical study (NCT02915432) led by Professor Xu Ruihua from Sun Yat-sen University Cancer Hospital
.

The purpose of this study is to evaluate the safety and efficacy of teriprizumab as a single agent in the treatment of refractory advanced gastric cancer patients who have failed chemotherapy, and to evaluate the predictive value of PD-L1 expression and TMB on the efficacy
.

A total of 58 patients were enrolled.
The results showed that the objective response rate (ORR) of patients treated with teriprizumab was 12.
1%; the disease control rate (DCR) was 39.
7%; the median PFS was 1.
9 months, medium The overall survival (OS) was 4.
8 months
.

In the subgroup, the ORR of PD-L1 positive patients (37.
5%, 3/8) was significantly higher than that of PD-L1 negative patients (8.
5%); the ORR of patients in the high TMB group (TMB≥12/Mb) (33.
3%, 4 /12) was also significantly higher than that of patients (7.
0%) in the low TMB group (TMB<12/Mb)
.

The median OS in the high TMB group was significantly higher than that in the low TMB group (14.
6 months vs 4.
0 months, P=0.
038)
.

Conclusion: Teriprizumab alone shows promising anti-tumor effects in the second-line treatment of refractory advanced gastric cancer patients who have progressed after chemotherapy.
It can be used as a second-line rescue treatment plan after systemic chemotherapy fails
.

Compared with the expression status of PD-L1, high TMB may be a molecular marker for predicting the overall survival of teriprizumab in the treatment of advanced gastric cancer
.

At the ASCO GI online conference in 2021, a randomized, multi-center, double-blind, phase III RAINBOW-Asia clinical study jointly led by Professor Shen Lin from Peking University Cancer Hospital and Professor Xu Ruihua from Sun Yat-sen University Cancer Hospital announced the study Result
.

The study used ramucirumab + paclitaxel and placebo + paclitaxel in the treatment of advanced gastric or gastroesophageal junction adenocarcinoma, mainly to evaluate the effectiveness and safety of ramucirumab + paclitaxel in the second-line treatment of advanced gastric or gastroesophageal junction adenocarcinoma mainly in Chinese patients Sex
.

The common primary endpoints are PFS and OS
.

A total of 440 patients with advanced gastric or gastroesophageal junction adenocarcinoma who progressed after first-line chemotherapy from East Asia (most Chinese patients, Malaysia, the Philippines, and Thailand) were enrolled, and were randomly given ramucirumab + paclitaxel or placebo + paclitaxel at 2:1 Treatment
.

Ramucirumab + paclitaxel reached the preset primary end point in the second-line treatment of advanced gastric or gastroesophageal junction adenocarcinoma, and showed efficacy and safety consistent with key global registered clinical trials.
It is currently the first and only advanced gastric with Chinese patients as the main body Or a phase III study to confirm the clinical benefit of anti-angiogenic drugs combined with chemotherapy in the second-line population of gastroesophageal junction adenocarcinoma
.

Nanoparticle Albumin-bound Paclitaxel (Nab-ptx) can promote the transmission of ptx across endothelial cells by binding to albumin-specific receptor glycoprotein (gp60), with stronger anti-tumor activity
.

Compared with solvent-based traditional paclitaxel, nab-ptx can be administered at a higher dose in a shorter infusion time
.

After the two drugs are administered in equal doses, the dose of Nab-ptx reaching the tumor is 33% higher, and because nab-ptx does not require a hydrated ethanol solvent, it can be used for alcohol intolerant patients with fewer side effects
.

Nab-ptx has proved to have better curative effect than other traditional taxane drugs in its "high efficiency and low toxicity" mechanism and in the research of breast cancer, pancreatic cancer, lung cancer and other solid tumors
.

It also benefits in the treatment of refractory advanced gastric cancer
.

Refractory advanced gastric cancer: The ABSOLUTE study (Figure 1 can be enlarged) Figure 1.
Refractory advanced gastric cancer: The ABSOLUTE study The ABSOLUTE study is aimed at 741 patients with refractory advanced gastric cancer treated with first-line fluorouracil.
Randomized: Nab-ptx 3-week treatment group (260mg/m2, once every 3 weeks); Nab-ptx single-week treatment group (100mg/m2, once a week); Paclitaxel single-week treatment group (80mg/m2, once a week) )
.

The results of the study showed that the OS of the Nab-ptx single-week treatment group was not inferior to the paclitaxel single-week treatment group, and the PFS had a prolonged trend: Nab-ptx 3 weeks vs Nab-ptx single week vs.
Paclitaxel single week PFS were 3.
8 months vs.
5.
3 months vs 3.
8 months; ORR and DCR have an upward trend
.

In terms of safety, allergic reactions in the Nab-pt group were reduced.
The Nab-ptx 3-week program was 1%, the one-week program was 1%, and the paclitaxel one-week program was 5%
.

The results of the Phase II ABSOLUTE study of Nab-ptx for second-line treatment of unresectable or recurrent gastric cancer showed that the ORR of Nab-ptx for second-line treatment of unresectable or recurrent gastric cancer was 27.
8%, the DCR was 59.
3%, and the median PFS was 2.
9 months.
Median OS is 9.
2 months
.

The main grade 3/4 adverse reactions were lymphopenia (10.
9%), neutropenia (49.
1%), leukopenia (20.
0%), and peripheral neuropathy (23.
6%)
.

The results of the phase III ABSOLUTE exploratory study of patients with recurrence of gastric cancer and single peritoneal metastasis showed that the median PFS of the Nab-ptx group and the paclitaxel group were 5.
7 months vs.
3.
7 months (P = 0.
0024); the Nab-ptx group vs.
the paclitaxel group The median OS was 9.
9 months vs 8.
7 months (P = 0.
006)
.

In the 2020 version of the CSCO gastric cancer guidelines update, the new Nab-ptx single-agent chemotherapy recommendation as a second-line treatment for gastric cancer (Class 1B evidence) is a milestone, but it is still necessary to completely replace traditional taxanes in the field of gastric cancer in the guidelines.
A large amount of high-quality clinical research data is needed as support
.

It is believed that with the continuous in-depth research of Nab-ptx in the field of gastric cancer, it will play an important role in the comprehensive treatment of advanced gastric cancer or recurrent and metastatic gastric cancer
.

Apatinib is a new generation of small molecule vascular endothelial growth factor receptor-2 (VEGFR-2) tyrosine kinase inhibitor, and it is also the world's first small molecule anti-angiogenic target that has been proven safe and effective in the treatment of advanced gastric cancer Drugs
.

In May and August 2020, the journals Cancer Medicine and Cancer Management and Research successively published "Effectiveness and safety of low-dose apatinib in advanced gastric" by Professor Sun Guoping from the First Affiliated Hospital of Anhui Medical University as the corresponding author.
Cancer: A real-world study" research results add a strong evidence to the effectiveness and safety of apatinib in the second-line treatment of advanced gastric cancer
.

In this study, 82 patients received apatinib as a single-agent second-line treatment for advanced gastric cancer PFS for 5.
5 months
.

Apatinib + paclitaxel second-line treatment of advanced gastric cancer PFS for 6.
4 months
.

The adverse reactions above grade 3 were 18.
97%, and there were no unexpected adverse reactions and treatment-related deaths
.

Research conclusion: Apatinib single-agent second-line treatment of advanced gastric cancer has shown good curative effect, and the adverse reactions are well tolerated
.

Apatinib combined with chemotherapy is of great exploratory value in the second-line treatment of advanced gastric cancer
.

1.
3 Third-line therapy: Targeted drugs and immunotherapy.
Third-line therapy requires patients with advanced gastric cancer recurrence or advanced metastatic gastric cancer to be in good physical condition.
The approved drugs at home and abroad include apatinib, ramucirumab, PD-1 monoclonal antibody, etc.
Except for ramucirumab, other drugs are available in clinical practice in China
.

Authoritative guidelines at home and abroad recommend that apatinib be used for advanced gastric adenocarcinoma or gastroesophageal junction adenocarcinoma patients who have undergone at least two systemic chemotherapy in the past and have progressed or recurred.
This is the standard treatment plan after the failure of advanced gastric cancer system chemotherapy.
The gold standard for third-line and above treatment of advanced gastric cancer
.

The 2020 version of the CSCO Guidelines for Gastric Cancer is updated for comprehensive treatment of advanced gastric cancer: a third-line treatment plan, and apatinib is a Class I recommendation (Class 1A evidence)
.

(Figure 2 can be zoomed in) Figure 2 2020 CSCO Guidelines for Gastric Cancer Updates Comprehensive Treatment of Advanced Gastric Cancer: Third-line treatment plan In the treatment of advanced gastric cancer recurrence or advanced gastric cancer phase III study of apatinib, the single agent of apatinib was evaluated for second-line treatment Efficacy and safety of patients with advanced gastric cancer recurrence or advanced gastric cancer who have failed treatment
.

The primary end point was median OS, and the secondary end point was median PFS
.

The results of the study showed that the median OS and median PFS of the apatinib group were 1.
8 months and 0.
8 months longer than those of the placebo group, respectively, and were also significantly higher than the placebo group in terms of effective control of tumor progression
.

In the study of apatinib in the third-line treatment of advanced gastric cancer recurrence or advanced gastric cancer, the analysis of the protocol data set (PPS) showed that the median OS of the apatinib group was significantly longer than that of the placebo group by 2.
6 months, and it could effectively control the tumor Progress (central investigator evaluation DCR: 42.
05% vs 8.
79%, P<0.
0001; Independent Imaging Evaluation Committee evaluation DCR: 31.
82% vs 10.
99%, P=0.
0002)
.

In terms of safety, adverse reactions such as hypertension, proteinuria, diarrhea, fatigue, and hematological toxicity are all controllable
.

ATTRACTION-2 is the world’s first exploratory study of immunotherapy for advanced gastric cancer.
The main target population is gastric cancer patients in Asia.
A total of 493 patients from Japan, South Korea and Taiwan were included to evaluate the unresectable and unresectable treatment of nivolumab.
Effectiveness and safety in the treatment of advanced or recurrent gastric cancer/gastroesophageal junction (G/GEJ) cancer
.

(Figure 3.
1 can be enlarged) Figure 3.
1 ATTRACTION-2: The effectiveness of Nivolumab in the treatment of unresectable advanced or recurrent gastric cancer/GEJ 1-year follow-up data shows that Nivolumab can significantly reduce the risk of death by 38%, and Nivolumab can significantly reduce the risk of death by 38%.
The OS rate of the anti-group was significantly higher than that of the placebo group, 26.
2% and 10.
9%, respectively
.

The safety of nivolumab in gastric cancer is similar to previous solid tumor studies, and treatment-related adverse events (TRAE) are controllable
.

The 2-year extended follow-up found that the 2-year OS rates of the nivolumab group and the placebo group reached 10.
6% and 3.
2%, respectively; in the nivolumab group, there were 3 cases of complete remission (CR) patients.
The median OS of CR or partial response (PR) patients was 26.
6 months, the 1-year OS rate was 87.
1%, the 2-year OS rate was 61.
3%, and no new TRAEs were found during follow-up
.

The follow-up results further proved that nivolumab can significantly improve the OS of unresectable advanced or recurrent gastric cancer.
The 2-year OS rate is more than 3 times higher than that of the placebo group, and it can show a higher effective rate for patients with CR or PR.

.

ATTRACTION-2 Study: Benefits of Nivolumab group
.

(Figure 3.
2 can be enlarged) Figure 3.
2 ATTRACTION-2 Study: Benefits of Nivolumab Group The ATTRACTION-2 Study: Subgroup data of patients from Taiwan, China was announced at the CSCO Conference in 2019
.

Nivolumab can also bring excellent survival benefits to patients with advanced or recurrent gastric cancer in China
.

Among the patients in Taiwan, the ORR of the nivolumab group was 12.
5%, and the DCR was roughly the same as the overall population.
Nearly 50% of the patients had reduced tumor burden, the 1-year OS rate was 20%, and the 2-year OS rate was 10%.
The placebo group is 0%, and the safety is good
.

More notably, the 2-year median OS of the nivolumab group was also significantly better than that of the placebo group (5.
06 months vs 4.
11 months, P = 0.
0222)
.

ATTRACTION-2 Study: Survival benefits of subgroups of patients in Taiwan, China
.

(Figure 3.
3 can be enlarged) Figure 3.
3 ATTRACTION-2 Study: Subgroup Survival Benefits of Patients in Taiwan, China The KEYNOTE-059 Study (Cohort 1) included 259 patients ≥18 years of age, ECOG PS score 0 to 1, and recurrent gastric cancer (cohort 1) Measurement) or patients with metastatic G/GEJ cancer who have received at least 2 previous chemotherapy regimens before the second-line or above treatment fails and the disease progresses
.

Patients with PD-L1 CPS score ≥1 receive pembrolizumab 200 mg once every 3 weeks for 2 years or until disease progression/intolerable toxicity occurs
.

The primary endpoints were ORR, safety and tolerability assessed by RECIST1.
1
.

Evidence of Pembrolizumab in the treatment of advanced G/GEJ cancer: KEYNOTE-059 study (Figure 4 can be enlarged) Figure 4 Pembrolizumab in the treatment of advanced G/GEJ cancer Evidence: KEYNOTE-059 study Main findings: in cohort 1 Among the 259 patients, 76.
4% were male, and the median age was 62.
0 years
.

57.
1% of patients were PD-L1+
.

The median follow-up duration was 5.
4 months
.

ORR was 11.
2%, CR rate was 1.
9%, PR rate was 9.
3%, stable disease (SD) rate was 17%, and disease progression (PD) rate was 55.
6%
.

The ORR of PD-L1 positive patients was 15.
5%; the ORR of PD-L1 negative patients was 6.
4%
.

The median DOR was 16.
3 months and 6.
9 months, respectively
.

Grade 3-5 TRAEs occurred in 43 patients (16.
6%), which can be managed and controlled
.

Two patients discontinued treatment due to abnormal liver function and bile duct stenosis; two patients were fatal (acute kidney injury, pleural effusion)
.

The results of the KEYNOTE-059 (cohort 1) study proved that the use of pembrolizumab as a third-line treatment of advanced gastric cancer with PD-L1 CPS score ≥1 can improve the survival of patients with controllable safety
.

Established the status of pembrolizumab as a single agent in the third-line or above treatment of advanced gastric cancer
.

The results of the ATTRACTION-2 and KEYNOTE-059 studies (cohort 1) established the status of PD-1 monoclonal antibody in the third-line treatment of advanced gastric cancer
.

Based on the data of these two studies, the US FDA approved single-agent nivolumab and single-agent pembrolizumab for third-line treatment of PD-L1 CPS ≥ 1 relapsed or advanced G/GEJ cancer
.

Based on the research results of ATTRACTION-2 and KEYNOTE-059 (cohort 1), Chinese experts have updated the 2020 version of the CSCO Guidelines for Gastric Cancer Comprehensive Treatment of Advanced Gastric Cancer: In the third-line treatment plan, "nivolumab monotherapy" is added as a level I recommendation (1A) Class evidence); the use of pembrolizumab as a single agent for patients with advanced gastric cancer with PD-L1 CPS>1 is upgraded to a level II recommendation (class 1B evidence)
.

It can be seen that immune checkpoint inhibitors are playing an increasingly important role in the third-line treatment of advanced gastric cancer
.

The maintenance treatment of advanced gastric cancer after chemotherapy and/or targeted therapy and immune checkpoint inhibitor single agent and combination therapy are effective is still lacking prospective phase III randomized controlled clinical studies.
Therefore, such patients are recommended and encouraged to participate in clinical studies
.

Patients with advanced gastric cancer recurrence and advanced metastatic gastric cancer with contraindications to chemotherapy are expected to survive very short if they can only receive the best supportive treatment
.

For such patients, whether to take palliative chemotherapy requires multidisciplinary collaboration (MDT) to conduct adequate oncology evaluation, integrating the patient’s clinical characteristics, molecular biological characteristics, chemotherapy tolerance, risk of easing chemotherapy indications, and treatment of the patient or family members.
Willingness and other factors, after weighing the pros and cons of palliative chemotherapy, decide whether to adopt palliative chemotherapy
.

After oncology assessment, patients who are suitable for palliative chemotherapy can adopt appropriate single drug, low-dose starting, gradual adjustment of the dose, and combined drug strategy
.

In the course of treatment, it is necessary to evaluate the efficacy in time and closely observe the evolution of the original complications.
If palliative chemotherapy is effective and the symptoms are relieved, maintenance treatment may be considered, or participation in clinical research is encouraged; if the disease is not relieved or worsened, treatment should be terminated in time and given Palliative symptomatic and (or) best supportive treatment
.

2.
There is a long way to go to improve the overall comprehensive treatment of gastric cancer.
China has the highest incidence of gastric cancer in the world, and its age-standardized 5-year survival rate is 27.
4%
.

The Department of Oncology Surgery, First Affiliated Hospital of China Medical University, with the joint efforts of several generations of discipline leaders and their teams, has continuously explored scientific research and clinical research in the field of gastric cancer, as well as multidisciplinary, standardized and individualized comprehensive treatment of advanced gastric cancer.
, To make progress and development that has attracted the attention of the world
.

The five-year survival rate of comprehensive treatment for advanced gastric cancer is increasing year by year, and the 5-year survival rate after radical gastric cancer is 63.
7%
.

(Figure 5 can be enlarged) Figure 5 Five-year survival rate of advanced gastric cancer comprehensive treatment in the First Affiliated Hospital of China Medical University Due to the vast territory of China, between the economically developed coastal areas and the underdeveloped inland areas, the first-tier central cities and the third and fourth-tier cities The overall level of multidisciplinary standardized individualized comprehensive treatment of advanced gastric cancer under the framework of multidisciplinary cooperation varies between cities, between urban and rural areas, and is limited by regional economic development and hospital technology, conditions and equipment, although in the country At the national level, continuing education and training on standardized and comprehensive treatment of tumors has been conducted nationwide.
However, the overall level of standardized and individualized comprehensive treatment of gastric cancer is still far behind that of developed countries such as Europe, America, Japan, and South Korea
.

Therefore, there is a long way to go to improve the overall standardization and comprehensive treatment of gastric cancer and the 5-year survival rate of gastric cancer.
The prevention and treatment of gastric cancer urgently requires the country's efforts and the concerted and unremitting efforts of doctors from all over the country
.

3.
Concluding Remarks Affected by the high degree of heterogeneity, there are differences in epidemiological characteristics, clinicopathological characteristics, tumor biological characteristics, treatment strategies, etc.
between the more common distal gastric cancer in the East and the more common proximal gastric cancer in the West
.

There are still many controversies at home and abroad about the difficult clinical diagnosis and treatment of certain challenging gastric cancer
.

From the current status and progress of comprehensive treatment of advanced gastric cancer, based on clinical characteristics, pathological classification of multidisciplinary individualized comprehensive treatment is very important for advanced gastric cancer, but existing gastric cancer classifications, including Lauren classification and WHO classification, are important for clinical use.
The guiding significance is limited.
Re-recognizing gastric cancer from the molecular level and establishing a comprehensive treatment model for gastric cancer are problems that must be faced but cannot be avoided
.

Molecular classification of gastric cancer is evidence for the selection of individualized comprehensive treatment plans for patients with advanced gastric cancer, and is an effective way to evaluate the prognosis of patients and improve the efficacy of individualized comprehensive treatment
.

Multidisciplinary and individualized comprehensive treatment of advanced gastric cancer under the guidance of molecular classification is the future development direction.
New treatment plans tailored to patients are still on the way, and in-depth exploration is required for cooperation at home and abroad
.

To explore the difficulties in the clinical diagnosis and treatment of gastric cancer, it is necessary to proceed from the national conditions of China’s “major gastric cancer country”.
In clinical practice, we should refer to the National Health Commission’s "Guidelines for the Diagnosis and Treatment of Gastric Cancer (2018 Edition)" and the new version of the gastric cancer diagnosis and treatment guidelines, and make reasonable and appropriate treatments based on the patient’s condition.
The adjustment to measure the advantages and disadvantages of diagnosis and treatment, maximize the 5-year survival rate of advanced gastric cancer and reduce the mortality rate; maintain the quality of life of patients as much as possible, and extend the survival time of patients
.

Prof.
Changlin Zhao National Class III Professor, Chief Physician, Doctor of Medicine, Master Supervisor Director of the Department of Gastrointestinal Oncology, Xinhua Hospital Affiliated to Dalian University Head of Dalian Colon and Rectal Cancer Diagnosis and Treatment Base, Chinese Anti-Cancer Association, Standing Committee of Liaoning Colorectal Cancer Professional Committee, Chinese Anti-Cancer Association Member of the Standing Committee of the Liaoning Provincial Gastric Cancer Professional Committee Member of the Standing Committee of the Liaoning Base of the Abdominal Tumor Committee of the Chinese Medical Education Association Member of the Standing Committee of the Liaoning Provincial Tumor Marker Professional Committee Member of the Standing Committee of the Liaoning Provincial Tumor Biology and Targeted Therapy Professional Committee Member of the Liaoning Provincial Chemotherapy Professional Committee Member of the Chinese Medical Association Liaoning Provincial Tumor Branch Member of the Eighth and Ninth Committees of the Science Society Chinese General Surgery Literature (Electronic Edition) Editorial Committee Chinese Electronic Journal of Colorectal Diseases Special Expert Reviewer National Natural Science Foundation Project Review Expert National Health Commission Science and Technology Project Review Expert National Ministry of Education Science and Technology Project review expert, Professor Xu Huimian, National Second-Class Professor, Special Allowance Expert of the State Council, Doctoral Supervisor, Visiting Professor of Dalian University, Director of the Cancer Center of the First Affiliated Hospital of China Medical University, Director of the Oncology Branch of the Chinese Medical University 11th Chairman of the Chinese Anti-Cancer Association The chairman of the gastric cancer professional committee and other academic consultation experts of the Central Health Care Committee have long been committed to exploring the law of tumor metastasis and optimizing the work of clinical standard diagnosis and treatment.
They have made outstanding contributions to improving the level of tumor prevention and treatment in Liaoning Province and even the whole country.
Won the 10th Chinese Physician Award, Outstanding experts of the Liaoning Provincial Government, the first Liaoning famous doctor and other honorary titles successively presided over and undertook to publish 161 domestic core journal papers based on the Natural Science Foundation projects and 19 national, provincial and ministerial scientific research projects such as "863" and "973", included in SCI Published 93 papers, with a cumulative impact factor of more than 300, edited 2 monographs on gastric cancer.
In 2001 and 2006, it won the second prize of National Science and Technology Progress Award and a number of provincial and ministerial science and technology progress awards.
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Thematic written talk｜Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (2) 7.
Special written talk｜Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (3) 8.
Special talk｜Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (4)--Progress in surgical treatment and radiotherapy and chemotherapy for advanced gastric cancer recurrence 9.
Special talk｜Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (5)- -Progress in systemic drug therapy for recurrence or metastasis of advanced gastric cancer (1)