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China's liver cancer patients account for half of the world's patients, and in recent years, new drugs and new therapies have come out, bringing new choices and hopes to patients with advanced liver cancer. Tomorrow (April 26) evening, I have the honor to invite Zhao Hong, director of the Department of Hepatobiliary Surgery of the Cancer Hospital of the Chinese Academy of Medical Sciences, to share the "standardized treatment and cutting-edge therapy for liver cancer", and welcome everyone to go online on time!
Text | Zhang Yefan, Deputy Chief Physician, Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Medical Academy
Zhao Hong, Chief Physician, Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Deputy Director of the Department
Many people are asking: If the liver cancer reaches the middle and advanced stages, and even some patients cannot do surgery, is there really no hope?
This is not the case.
In recent years, with the advancement of various drugs and treatment technologies, we no longer have no weapons for intermediate and advanced liver cancer as we did 20 years ago. Now, surgery, interventional therapy and other technologies continue to advance; with the emergence of new drugs, even advanced liver cancer that cannot be operated on can be treated to prolong life and improve quality of life. Many patients are far better off than we previously expected.
Today we will introduce some new treatments for liver cancer.
Targeted therapy
As the name suggests, targeted therapy is like a missile, with the goal of attacking the tumor with precision, without harming the rest of our body's normal cells. Therefore, the side effects of targeted therapy are generally more controllable than those of chemotherapy. Targeted therapy for liver cancer in China began in 2007, and sorafenib, as the only first-line drug for advanced liver cancer, has brought hope to patients. However, its efficacy is not satisfactory enough, because the overall efficiency is low and the time to prolong life is limited.
Fortunately, in recent years, new drugs have developed rapidly, and some new targeted drugs have entered the treatment category of liver cancer, such as lenvatinib, caboztinib, etc., which have been approved as the first-line and second-line drug choices for liver cancer treatment, respectively. In clinical studies, the median survival time of advanced liver cancer, from the original less than 10 months, to a single drug can reach about a year, further improving the prognosis of patients. The domestic new drug donalfenib also achieved positive results in the study and was included in the first-line treatment guidelines.
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Immunotherapy
In recent years, the hottest thing in the medical community may be immunotherapy. Immunotherapy refers to enhancing their own immunity through various channels, especially the ability to recognize tumors and kill tumors, so as to achieve anti-tumor effects.
At present, the hottest immunotherapy drugs are PD-1/PD-L1 immune checkpoint inhibitors, which achieve negative and negative positive and strengthen immune effects by inhibiting the signal of reducing immunity. A number of imported and domestic drugs have been approved for marketing, treating a wide variety of tumors.
In the treatment of liver cancer, the effect of immunotherapy with single drugs is limited, so at present, we mainly consider combination therapy: including immune drugs + targeted drugs, immune drugs + immune drugs, etc., to jointly treat liver cancer.
Let's talk about immune drugs + targeted drugs.
If targeted therapy is the sword that cuts at the tumor, then immunotherapy can be understood as the armor worn on the body, by improving its own immunity, to achieve anti-tumor effect. So when we encounter liver cancer, we naturally think, why can't we wear both armor and a sword?
In the treatment of liver cancer, such ideas have been put into practice. For example, last year's blockbuster IMBrave150 study used immune drugs (atenizumab) and targeted drugs (bevacizumab) to treat liver cancer, and the results achieved a major breakthrough. The efficacy of combination therapy is much higher than that of previous monotherapy targeted therapy: the median survival of patients with advanced liver cancer has suddenly extended from about 1 year to 2 years!
This is not the only good news. Scientists have shown that in addition to the two drug combinations used in IMBrave150, there are other combinations of targeted drugs and immune drugs that can bring 1+1>2 effects. For example, the KEYNOTE-524 study proves that the effect of pambolizumab (K drug) + lumpatinib for first-line treatment is also very good.
Domestic drugs also have good performance. For example, the recently released ORENT-32 study of the domestic sindilliumab + bevacizumab analogue, as well as the RESCUE study of carellizumab + apatinib, their data are still relatively early, but they also look promising.
Immunity can be used not only with targeted drugs, but also with other immune drugs. At present, the most common are PD-1/PD-L1 immune drugs + CTLA4 immune drugs.
Navulijumab (O drug) + CTLA4 drug ipilimumab, due to its remarkable efficacy, has been approved for the second-line treatment of liver cancer in 2020. In addition, PD-L1 drugs (duvalliumab) + CTLA-4 drugs (Tremelimumab) achieved a good median survival of 18.7 months in first-line clinical studies of liver cancer.
These are just the tip of the iceberg, and there are now many clinical studies of new therapies for liver cancer. I believe that there will be more and more exciting good results gradually reported. Therefore, even if inoperable advanced liver cancer is found, we should not be discouraged and give up, there are many treatments to deal with, not only new drugs on the market, but also many clinical studies that can be tried.
Interventional therapy
Interventional therapy for liver cancer refers to a local treatment in which an anticancer drugs or embolic agents are injected into the hepatic arteries through arterial intubation. Its advantage is that it does not require open surgery, the trauma is small, and at the same time, it can achieve a relatively high drug concentration locally, and the treatment effect is better.
In recent years, interventional therapy has been advancing, and its role in liver cancer has also been continuously enhanced. For example, "HAIC therapy", that is, transhepatic artery perfusion chemotherapy. This method is to achieve the purpose of killing tumor cells by perfusing chemotherapy drugs into the hepatic artery for a long time. HAIC has achieved very significant results in the treatment of liver cancer.
In the past, interventional therapy was mainly used with chemotherapy drugs, but now with targeted drugs and immune drugs, we can't help but think: if we play the advantages of intervention, targeted therapy and immunotherapy at the same time, can we get a better effect? This is a direction that we are currently actively exploring professionally.
All in all, the exploration of liver cancer treatment by doctors and researchers is diverse and continuous. In addition to the above-mentioned targeted therapy, immunotherapy, interventional therapy, combination therapy, in fact, there are many other new treatment methods, such as cellular immunotherapy, new radiotherapy, etc., but they are still relatively early, and the results have yet to be verified.
I believe that in the future, the treatment effect of liver cancer will continue to improve, and it will no longer make everyone smell as much as it once did.
Hail to life!
*This article aims to popularize the science behind cancer treatment, not drug promotional materials, and it is not a treatment plan recommendation. For guidance on treatment options, visit a regular hospital.
Zhang Yefan
Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences
Deputy Chief Physician
Zhao Hong
Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences
Chief Physician, Deputy Director of the Department
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