In recent years, the 5-year survival rate of cancer in China has improved significantly, from 30.9% in 2003-2005 to 40.5% in 2012-2015. The improvement in survival rate is attributed to the promotion of cancer screening and multidisciplinary treatment, the implementation of precision oncology, the continuous innovation of new drug research and development, as well as the well-being of the people, the improvement of income levels, and the popularization of healthcare.
On December 12, 2023, Professor Shen Lin's team from Peking University Cancer Hospital was invited to discuss the research status and future development direction of cancer diagnosis and treatment in China with the title of "The landscape of cancer research and cancer care in China" in the international top medical journal Nature Medicine. Addressing the challenges and issues facing China in cancer diagnosis, treatment, and R&D will help develop new strategies to combat cancer, thereby reducing the global cancer burden. The study outlines tumor screening strategies, multidisciplinary integrated treatment, precision oncology medicine, new drug research and development, and other aspects.
Cancer screening and prevention
The focus of cancer prevention in China includes the control of risk factors, the prevention of chronic infection, the expansion of vaccination, the implementation of tobacco control measures, and the resolution of environmental pollution. Since 2012, the country has launched cancer screening programs, which has greatly improved the rate of early diagnosis of tumors. In addition, the development and application of esophageal cancer risk prediction models by Chinese researchers in high-risk areas has promoted the implementation of accurate screening. Based on a number of studies at home and abroad, Chinese cancer screening guidelines have been formed, including gastric cancer, esophageal cancer, liver cancer, colorectal cancer, lung cancer, breast cancer, cervical cancer and nasopharyngeal cancer. The Chinese Anti-Cancer Association and the Chinese Society of Clinical Oncology have raised the public's awareness of cancer prevention and treatment and popularized a healthy lifestyle through the Cancer Prevention and Treatment Publicity Week and various media platforms.
Development of multidisciplinary teams
In recent years, the concept of multidisciplinary team integrative therapy (MDT) has become a basic principle of oncology treatment. In 2015, the MDT Special Committee of the Chinese Medical Doctor Association was established to promote the implementation of MDT in hospitals at all levels across the country. Since then, MDT has made a number of progresses, including the implementation of MDT strategies such as the three-step process. Patients treated with MDT had significantly longer survival. However, it is still necessary to continuously improve and expand MDT and improve the efficiency of MDT to serve more patient populations.
Figure 1. MDT History
Precision oncology applications
Precision therapy has become an important part of the diagnosis and treatment of a variety of tumors (Figure 2), especially lung cancer, breast cancer, gastrointestinal cancer, and urinary system tumors. In addition, the government has set up research funds to support doctors and scientists in conducting basic and translational research on tumors. Encouraging interdisciplinary collaboration to study rare tumor types has strongly promoted the development of precision therapy.
Fig.2 Targets for precision therapy of solid tumors (recommended by CSCO guidelines)
In addition to the widespread application of precision medicine in advanced tumors, this concept has also been gradually extended to the perioperative period. With the rapid development of radiomics and artificial intelligence, multimodal models that integrate radiomics, pathomics, and molecular features will assist in treatment decision-making and achieve precision oncology. Although precision oncology has made some progress, there are still challenges to its promotion, including regional differences, the need to strengthen physician education and training, and the need to improve the clinical translation of scientific research results.
Progress in the research and development of new cancer drugs
Since 2015, China has issued a series of reform measures and guidelines for new drug review, clinical study design and execution, clinical research data supervision, and protection of subjects' rights and interests, which has kicked off the rapid development of new drug research and development in China. Since 2015, the number of clinical studies has increased year by year, especially in the early stages (Figure 3). More and more Chinese researchers have emerged in the world's early clinical research, and China has gradually gained world recognition in the research and development of new anti-tumor drugs in the world. In addition, while China's new drug research and development is following the global megatrend, the attention to the special subtypes of high-incidence tumors and common tumors unique to China has increased significantly. The existing research and development of new drugs is mainly targeted therapy, immunotherapy, and target-drug conjugates, followed by cell therapy, and the continuous development of traditional Chinese medicine, chemotherapy, vaccines and other drugs. In terms of therapeutic targets, PD-1/PD-L1, VEGFR, EGFR, and HER2 are the main ones. Taking PD-1/PD-L1 as an example, while focusing on nasopharyngeal cancer and esophageal cancer unique to China, the treatment of these drugs has gradually advanced from the back line to the first-line treatment, adjuvant and neoadjuvant therapy. The combination therapy strategy of PD-1/PD-L1 has gradually become the focus of future research and development. A variety of PD-1/PD-L1 products have been launched in China, which has improved the accessibility of drugs, and some drugs have been negotiated through medical insurance, reducing the burden on patients and medical insurance.
Fig. 3 R&D progress of new drugs (monoclonal antibodies, bispecific antibodies, ADCs, TKIs, vaccines, etc.) for solid tumors in China from 2015 to 2022
China's new drug R&D has gradually shifted from me too and me better drug R&D to first-in-class drug R&D, focusing on the R&D of innovative targets, such as HPK1, BTLA, IRE1, etc. In addition, China has established a self-developed platform for the synthesis of bispecific antibodies and target-conjugated drugs, which has enabled a large number of bispecific antibodies, bispecific antibody ADCs, and biligand ADCs to enter the clinical research stage. However, most of the new drugs lack preclinical synergistic analysis on how to select bispecific antibody matching targets, which poses challenges to the safety management and factorial analysis of efficacy after subsequent clinical studies.
Cell therapy for solid tumors is an important part of the research and development of new drugs, and the number of studies has steadily increased in recent years, leading the world. Among them, CAR-T research and development is at the forefront, followed by NK-T, TCR-T, and TIL cell therapy. The main research targets were Claudin18.2, MSLN, Mucin-1 and GPC3. Claudin18.2-CART treatment has seen preliminary efficacy in a Phase 1 clinical study for advanced gastric cancer, and a follow-up Phase II-III clinical study is ongoing. However, there are urgent issues to be addressed regarding tumor heterogeneity, the impact of tumor suppression microenvironment in solid tumors on efficacy, safety management, and high treatment costs.
Fig. 4 R&D progress of cell therapy for solid tumors in China from 2015 to 2022
Investigator-initiated clinical studies (IIT) are conducted according to the needs of clinical research, mainly in phases 1-2, of which cell therapy accounts for the majority of IIT studies. In recent years, the state has strengthened the supervision of IIT to ensure the quality of research, but at present, IIT research still lacks sufficient funding and human support, and further improvement is still needed.
conclusion
Although the large patient population has brought lasting challenges to the diagnosis and treatment of cancer, the promotion of cancer prevention and screening, the promotion of multidisciplinary team integrated treatment and precision treatment models, and the rapid development of new drug research and development have had a significant impact on the national scale. In the future, we will be able to continuously improve treatment strategies and ultimately prolong the survival of patients by advocating comprehensive and individualized patient diagnosis and treatment, pioneering innovative treatment methods, achieving breakthroughs in precision medicine and new drug research and development, and strengthening the collaboration between health practitioners, researchers, and policymakers. The development of cancer diagnosis and treatment and R&D in China will enhance the role of anti-cancer on a global scale.
Corresponding author: Prof. Lin Shen
Chief physician, professor and doctoral supervisor
Director of the Department of Digestive Oncology and Director of Phase I Clinical Trial Ward, Peking University Cancer Hospital
Beijing Scholar
Beijing Outstanding Contribution Expert
Chairman of the Tumor Precision Therapy Professional Committee of the Chinese Anti-Cancer Association
The first chairman of the Clinical Research Committee of Cancer Drugs of the Chinese Anti-Cancer Association
Chairman of the Clinical Research Expert Committee of the Chinese Society of Clinical Oncology
He is the chairman-designate of the Gastric Cancer Expert Committee of the Chinese Society of Clinical Oncology
She is the chairman of the Clinical Oncology Committee of the Chinese Women Physicians Association
Editor-in-chief of the Electronic Journal of Comprehensive Oncology Therapy
Contributed by: Department of Digestive Oncology, Peking University Cancer Hospital
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