Xu Binghe, academician of the Chinese Academy of Engineering: Strengthen the construction of tumor diagnosis and treatment demonstration centers and promote the sinking of high-quality medical resources

"Now there are many anti-tumor drugs, and some drugs are not known to be used in many grass-roots hospitals, so it is necessary to strengthen the construction of regional medical centers, promote hierarchical diagnosis and treatment, and strengthen standardized treatment." On February 18, at the symposium on "Standardizing The Clinical Use of Cancer and Ensuring Medical Quality and Safety" sponsored by the People's Political Consultative Conference Daily and the People's Political Consultative Conference Network, Xu Binghe, academician of the Chinese Academy of Engineering, chairman of the Breast Cancer Expert Committee of the National Center for Oncology Quality Control, and professor of the Cancer Hospital of the Chinese Academy of Medical Sciences, was interviewed by reporters on the current situation of breast cancer diagnosis and treatment in China, the rapid approval of new drugs, and the expansion of high-quality medical resources.

Reporter: What is the current situation of breast cancer diagnosis and treatment in China? Is there a gap compared to Western countries?

Xu Binghe: Breast cancer has become the first malignant tumor in the incidence of women in mainland China, especially in recent years, the incidence of breast cancer in mainland China has increased very rapidly. However, compared with other cancers, breast cancer has a better effect. In foreign countries, especially in developed countries, the 5-year survival rate of breast cancer has exceeded 90%, about 90% to 93%. The overall 5-year survival rate of breast cancer in mainland China is more than 80%, so there is still a certain gap compared with foreign countries. But in some large cancer centers, such as our hospitals, the 5-year survival rate of breast cancer patients has actually reached 93%, which is the same as that of developed countries.

There are still differences in the level of diagnosis and treatment and resource allocation in various regions of China. In general, the treatment effect of patients in large cities is better than that in small and medium-sized cities, the efficacy of large specialized hospitals is better than that of general hospitals, the long-term survival rate of breast cancer in underdeveloped areas is higher than that in underdeveloped areas, and in cities it is also higher than in rural areas. The reason for the difference is mainly whether the diagnosis and treatment is standardized. In some more remote areas, there is no oncologist for various reasons, there are problems such as relatively irregular treatment, and patients are found relatively late. Therefore, follow-up population screening is needed to detect early breast cancer patients early.

Reporter: From following foreign research more than a decade ago to now leading international multi-center collaborative research, how do you evaluate this change?

Xu Binghe: The improvement of the efficacy of breast cancer patients must be studied. Research includes basic, translational and clinical studies, especially clinical studies, which, once successful, have the potential to change clinical practice. Carrying out clinical research in China is first of all to follow foreign countries, and in the process of participation and follow-up, we have accumulated a lot of experience. Since then, some multi-center clinical studies have also been carried out in China, including publishing the clinical research results of new drugs in top international journals, which has an increasing impact. In fact, we are currently leading the way in some areas of clinical research.

Reporter: In recent years, the mainland has continuously reformed and innovated the drug review and approval mechanism, and completed the approval at the fastest speed for some new drugs that are particularly needed, including many new anti-cancer drugs.

Xu Binghe: There are two reasons why this drug should be accelerated for review and approval. One is to approve the listing relatively early, some are approved for marketing based on the results of type II clinical trials, and even some rare tumors with a very low incidence are approved for marketing based on the results of primary clinical trials, which has actually been done abroad. Especially in the field of solid tumors, such as a new TKI anti-HER2-targeted drug for the treatment of breast cancer, pyrrolidinib, based on its very good efficacy and superior to international standard treatment protocols, we have created the first rapid approval and listing based on secondary clinical trial results.

The second aspect is to meet clinical needs. For example, a foreign small molecule targeted drug has a good efficacy and a very low risk ratio. Based on this result, the State Administration for Market Regulation agreed to give conditional and rapid approval for listing. Based on the results of the phase II clinical trial, it can be approved for listing, requiring us to do another phase III clinical trial, and if the results of the phase III clinical trial are confirmed to be the same as the phase II, then it is officially approved for listing. This allows the drug to be marketed 3-4 years in advance, which can benefit more tumor patients early.

Reporter: The state has promoted the reform of the medical insurance system and allowed more and more innovative drugs to be included in the medical insurance directory.

Xu Binghe: It is very important for the National Medical Insurance Bureau to negotiate new drugs. First, it can push a lot of particularly good anti-tumor drugs to the clinic, provide doctors with more treatment drugs, provide patients with more treatment options, and can benefit the majority of tumor patients, which is a good initiative.

Second, the most effective drugs into the medical insurance list, some drugs if the efficacy and the effect of the standard treatment plan compared, the difference is not particularly large, can be slowed down; can significantly improve the long-term survival rate of patients drugs, I think it is more important to push to the clinic as soon as possible. Because clinically you cured the patient, and you treated the patient in the advanced stage after the recurrence of metastasis, this is a completely different concept. If the long-term survival rate of patients can be significantly improved in the early stages, it is more important than standard treatment.

Reporter: As a clinical expert at the National Cancer Center, how do you think you can sink better medical resources to a wider area and benefit more patients?

Xu Binghe: On the one hand, it is necessary to strengthen standardized treatment. Some drugs are many grass-roots hospitals do not know how to use, so it is necessary to strengthen the construction of regional medical centers. It is not possible for the National Research Centre to cover all hospitals in the country, and one of its important tasks is to strengthen collaboration with local authorities. For example, regional cancer centers and provincial cancer centers will be established, and high-quality resources and effective treatment methods will be promoted to the next level of radiation through regional medical centers.

On the other hand, it is necessary to strengthen the construction of diagnosis and treatment demonstration centers. A National Oncology Complaint Centre was established through the National Cancer Centre, and the first batch of 200 hospitals is now involved. We have also set up a national anti-tumor drug clinical monitoring center in various ways to monitor the rational use of drugs to see if you use some good drugs rationally on patients and ultimately benefit patients.

Reporter: Fu Zhenqiang

Video: Liu Jiazheng Lai Renjie

EDIT: Mo Shuo

Review: Jiajia Zhou