Multi-Stakeholder Initiative Proposes Comprehensive Care Model to Extend Survival in Liver Cancer Patients Amid Immune Therapy Breakthrough

A large-scale analysis published in The Lancet in 2019, examining the disease burden and risk factors in China over the past four decades, revealed that liver cancer has become one of the top five causes of premature death among Chinese people. Known as a country with a high burden of liver cancer, China accounted for nearly half of the global new cases and deaths from liver cancer in 2018, according to WHO estimates. Furthermore, its five-year survival rate is the lowest among common cancers, at only 12.1%.

“Multi-Party Initiative Launch Ceremony for Improving Long-Term Survival of Liver Cancer Patients in China”

Today, during the 17th National Academic Conference on Liver Cancer, Zhongshan Hospital of Fudan University, in collaboration with liver cancer patient organizations and with support from Roche, jointly launched an initiative to improve long-term survival among liver cancer patients in China. The initiative calls for multi-stakeholder collaboration to establish a comprehensive disease management system for liver cancer patients across the entire care continuum, promote standardized diagnosis and treatment of liver cancer in China, further enhance patients’ quality of life, maximize survival benefits, and achieve the goal of long-term survival.

Despite Continuous Advances in Medical Technology, the Prevention and Treatment of Liver Cancer Remain a Formidable Challenge

The high heterogeneity, drug resistance, and dynamic complexity of the onset and progression of liver cancer result in extremely high recurrence and mortality rates. Various pathogenic factors, such as hepatitis B/C, alcoholic liver disease, diabetes, and other chronic conditions, lead to significant heterogeneity at the initial stage of liver cancer formation. Furthermore, this heterogeneity continues to intensify during the progression from hepatitis to cirrhosis and liver cancer, as well as during treatment, posing substantial challenges to clinical management.

Academician of the Chinese Academy of Sciences and Director of Zhongshan Hospital Affiliated to Fudan University in Shanghai, Fan Jia, Delivers a Speech

“Due to the insidious onset of liver cancer and the lack of specific symptoms in its early stages, approximately 80% of patients are already at an advanced stage upon initial diagnosis, thereby losing the opportunity for curative surgery. Even with curative surgical treatment, 60–70% of patients experience metastasis and recurrence within five years. The high propensity for metastasis and recurrence is the primary factor affecting long-term patient survival,” shared Fan Jia, Academician of the Chinese Academy of Sciences and President of Zhongshan Hospital Fudan University in Shanghai. “Improving overall patient survival is an urgent challenge that needs to be addressed in the field of liver cancer treatment in China today, and it remains the original aspiration of every medical practitioner.”

In recent years, China has made significant progress in the diagnosis, treatment, and research of liver cancer. Through the relentless efforts of generations of medical professionals and researchers specializing in liver cancer, rapid advancements have been achieved in surgical interventions, targeted therapy, and immunotherapy. This year, the liver cancer research team at Zhongshan Hospital, represented by Academician Fan Jia, achieved several major breakthroughs in research and development technologies. Among these was a groundbreaking study that leveraged a large-scale proteogenomic platform to conduct the world’s first systematic “multi-omics, multi-level, and multi-dimensional” analysis of hepatitis B virus-related hepatocellular carcinoma, using 159 surgically resected tumor samples. This work provides direction for the future development of personalized precision diagnosis and treatment of liver cancer.

With the continuous advancement of medical technology, the five-year survival rate for liver cancer patients in China has significantly improved. However, due to characteristics such as the high heterogeneity of liver cancer, the overall long-term survival of liver cancer patients remains unsatisfactory, and the prevention and treatment of liver cancer still face significant challenges.

Major Breakthrough in First-Line Treatment for Hepatocellular Carcinoma Ushers in a New Era of Combination Immunotherapy

This is a true patient story. Mr. Weng Yan, the protagonist of the story, was 33 years old, with a gentle wife and an adorable child who had just turned two. An avid sports enthusiast, he never imagined that his sudden physical discomfort would be caused by liver cancer. At first, neither he nor his family could accept the diagnosis. However, the tumor rapidly grew to 16 centimeters, and the quickly progressing disease left them no room for hesitation. Mr. Yan immediately underwent surgery, but unfortunately, the cancer recurred and progressed postoperatively. After trying various treatments, he began participating in multiple clinical trials. Fortunately, he was enrolled in the IMbrave150 study. After the first, second, and third doses, it was during the fourth and fifth doses that the tumor finally began to shrink.

“I see hope for a cure, because once this therapy takes effect, it is long-lasting,” said Mr. Yan happily. He expressed his hope that the therapy would be brought to market as soon as possible, so that more patients could benefit from it.

IMbrave150 was a global, Phase III, multicenter, open-label study conducted in 501 patients with unresectable hepatocellular carcinoma who had not previously received systemic therapy. Patients were randomized in a 2:1 ratio to receive combination therapy with atezolizumab and bevacizumab or sorafenib. Atezolizumab was administered intravenously at a dose of 1200 mg on Day 1 of each 21-day cycle; bevacizumab was administered by intravenous infusion at a dose of 15 mg/kg on Day 1 of each 21-day cycle. Sorafenib was administered orally at a dose of 400 mg twice daily on Days 1–21 of each 21-day cycle. Patients received either the combination therapy or the control treatment until unacceptable toxicity occurred or the investigator determined there was no clinical benefit.

At the recently concluded ESMO Asia Congress 2019, the results of the IMbrave150 study were released, drawing significant attention from the medical community. The results demonstrated that the combination of atezolizumab and bevacizumab (T+A) not only significantly improved overall survival (OS) and progression-free survival (PFS) in patients with unresectable hepatocellular carcinoma, but also enhanced tumor response rates. Compared with sorafenib, the T+A immunotherapy combination reduced the risk of death (OS) by 42% and the risk of disease progression or death (PFS) by 41%. Furthermore, regarding safety, the safety profile of the T+A regimen was consistent with the previously known safety profiles of the individual agents when used alone.

This study has become the first successful Phase III clinical trial of combination immunotherapy for liver cancer globally, marking a major breakthrough in the first-line treatment of unresectable hepatocellular carcinoma in nearly 11 years.

Speech by Sun Huichuan, Deputy Director of the Liver Cancer Institute at Zhongshan Hospital

“The T+A regimen holds milestone clinical significance and will have a profound impact on transforming the entire diagnosis and treatment paradigm for liver cancer,” stated Professor Sun Huichuan, Deputy Director of the Liver Cancer Institute at Zhongshan Hospital. “For the first time in over a decade, we have observed study data demonstrating a significant improvement in objective response rates compared to current standard therapies, thereby potentially enabling initially unresectable liver cancer patients to become candidates for surgery and offering the prospect of long-term survival or even potential cure.”

Notably, as a key participant in the IMbrave150 clinical study, the liver cancer expert team from Zhongshan Hospital, led by Academician Fan Jia, promptly identified that the restrictions on traditional Chinese medicine (TCM) in the enrollment criteria were not aligned with China’s national conditions. The team contacted the global clinical lead of the trial and, on behalf of Chinese experts, provided valuable professional clinical insights, which led to modifications in the final enrollment criteria, thereby enabling more Chinese patients to benefit from this immunotherapy combination regimen.

Co-building a Full-Course Disease Management System for Patients: Total Survival of Liver Cancer Patients Expected to Rise Rapidly

Liver cancer diagnosis and treatment have now entered the era of comprehensive care, with precise staging, integrated multidisciplinary team (MDT) collaboration, and personalized medicine emerging as the future directions. The development of liver cancer from onset to end-stage is a long-term, systematic, and chronic process; therefore, great emphasis must be placed on comprehensive intervention and whole-course management.

As an industry leader, Zhongshan Hospital has pioneered the concept of “whole-course patient management” in the clinical diagnosis and treatment of liver cancer. By adopting a multidisciplinary team (MDT) model, it formulates optimal combined diagnostic and therapeutic regimens for patients with liver cancer, integrating local and systemic treatments to achieve the ultimate goals of alleviating symptoms, prolonging survival, and even attaining cure. However, China still lacks a relatively comprehensive whole-course management system for liver cancer patients, necessitating collaborative efforts among multiple stakeholders to explore and establish such a framework.

As a global leader in personalized healthcare, Roche has accumulated extensive experience in the long-term survival management of patients with breast cancer and lymphoma. Building on this foundation, Roche shared its vision for establishing integrated centers for standardized diagnosis and treatment of hepatocellular carcinoma (HCC) at the conference. These centers will integrate online and offline diagnostic and therapeutic resources, creating exclusive communities for both patients and physicians. Through the dedicated online patient community, patients can promptly access disease-related knowledge, tailored patient education materials, and medical consultation information, while also interacting with experts. Meanwhile, the exclusive physician community will enable doctors to initiate online consultations, deliver disease education, and review patient reports. Patients requiring further treatment can locate affiliated hospitals within the integrated center network via an infusion map to complete offline diagnosis and therapy. By leveraging these integrated diagnosis and treatment centers—which offer multifunctional, whole-disease-course management covering screening, diagnosis, treatment, and follow-up—liver cancer patients will receive one-stop diagnostic and therapeutic services, thereby further improving treatment outcomes and enhancing long-term survival.

Roche Pharmaceuticals ChinaMedicineLi Wei, Vice President of the Department, Delivers Speech

Li Wei, Vice President of the Medical Department at Roche, stated, “Roche is honored to join hands with Zhongshan Hospital and patient organization representatives today to launch an initiative aimed at establishing a comprehensive whole-disease-course management system for liver cancer patients in China. Long-term survival is an urgent need for every liver cancer patient. Adhering to its principle of ‘acting in the best interests of patients first,’ Roche is committed not only to bringing innovative medicines to Chinese patients at the earliest opportunity but also to collaborating with partners across sectors to advance the diagnosis and treatment of liver cancer. By promoting the establishment of a whole-disease-course management system, we aim to elevate the overall standard of liver cancer care in China, enable more patients to achieve high-quality long-term survival, and realize the vision of curing liver cancer sooner.”