Professor Fu Xiaohui, Professor Tang Zhaohui, and Professor Shi Yinghong talked about the big coffee, talk about the BTC conversion treatment model and future development | Sword Gold Heroes

*For medical professionals for reading reference

Big coffee dialogue, indicating the future development direction of BTC, come and check in!

In 2022, Soffinib experts interviewed the "Sword Gold Heroes" officially opened. Experts from all walks of life were present to focus on the diagnosis and research of BTC to discuss "diagnosis and treatment cheats" to explain more clinical doctors. The first phase of "Sword Gold Heroes" was broadcast on September 8. This conference invited Professor Fu Xiaohui, Shanghai Oriental Hepatobiliary Surgery Hospital, Professor Tang Zhaohui, Xinhua Hospital affiliated to Shanghai Jiaotong University Medical College, and Professor Shi Yinghong, Affiliated to Fudan University. Personal clinical insights were published on the "BTC conversion therapy model exploration and thinking".

The new generation of "cancer king"? Where is BTC treatment?

Professor Fu Xiaohui: BTC treatment is recognized as "difficulty" in the industry whether surgery or systemic treatment. I also want to ask two professors during this opportunity. What are the aspects of BTC treatment?

Professor Shi Yinghong: Patients with BTC are often late when confirmed, so the proportion of patients who can truly accept surgical resection is not high. In addition, BTC is actually a relatively good concept, including intrahepatic bile duct cancer, hepatotes of bile duct cancer, distal bile duct cancer, and even gallbladder cancer. The prognosis is not very good. From the perspective of BTC's systematic treatment, the famous ABC-02 studies have shown that compared with the Jesitabin single-medicine Gibi Binbin combined cisplatin (GC) can significantly prolong the patient's median no progressive survival (PFS) and median total survival (OS), which laid the laid laid laid laid laid The status of the GC scheme in the late BTC first -line treatment. At the same time, the importance of BTC surgery treatment is irreplaceable, but BTC surgical treatment still faces a certain dilemma: the R0 resection rate is low, the recurrence rate is high, most patients are difficult to cure, and the positive lymph node rate is high.

Professor Tang Zhaohui: Due to the different anatomical parts of the gallbladder, there are high heterogeneous heterogeneity in intrahepatic bile duct cancer, outer and outer hepatic bile duct cancer, gallbladder cancer, and pot abdominal cancer. Many difficulties, the difficulty of surgery, the high degree of fine requirements, long time and so on. Hepatoma combined vascular resection and liver pancreatic duodenal sorceration (HPD) are the main two types of surgery of biliary tumor, which is recognized as a difficult type of surgical. In addition, due to the lack of the relevant knowledge of BTC's symptoms and screening methods, the public often appears to see the medical treatment such as jaundice, ascites, and even far away. Opportunities for surgery. Therefore, how to create surgical conditions for the initial incurable patients is also an important direction for clinicians to explore.

Two "sharp blades" of hand -in -hand surgery and drugs, Like BTC treatment difficulties

Professor Fu Xiaohui: As a clinician, the "weapon" on our hands also has drugs besides the surgeon. It is very gratifying that the treatment of tumors has changed dramatically in recent years. The two professors introduced us to related research progress.

Professor Tang Zhaohui: In order to improve the success rate of BTC from irregularity to removal and improve prognosis, two or more solutions are combined with transformation therapy or become the main research direction of the future. Some patients who cannot surgery can achieve tumor load, lymph node metastasis, or remote metastatic disappearance through radiotherapy, chemotherapy, targeted therapy, immunotherapy, etc. In addition to narrowing the tumor, transformation therapy also pays attention to the treatment of liver function and reverses clinical problems such as jaundice and other patients; followed by liver volume conversion, patients with HPD and other surgical liver cannot meet the needs of normal physiology. At this time, PVE or PVE or Alpps to retain the volume of the side liver, so as to really benefit patients.

Professor Shi Yinghong: After the study of ABC-02, in fact, the progress of BTC's drug research has stagnated for a while. With the advent of the target era, BTC drug treatment has taken a big step forward: Topaz-1 research: Topaz-1 Research is a random, double -blind, placebo control, and the global multi -centered phase III clinical trial. It aims to evaluate the effectiveness and safety of the combined chemotherapy for the combined chemotherapy for the combined standard chemotherapy of the first -stage BTC. The end is OS. The results of the research show that comparison of standard chemical chemotherapy, Daguyuki combined chemotherapy can bring significant survival benefits [1].

"Three Medicine and Four Medicine" research: Under the lead of Academician Fan Jia and Professor Zhou Jian, Zhongshan Hospital affiliated to Fudan University carried out Gemox chemotherapy and Tripley Mipide and Lelipini first -line treatment of advanced biliary tumors. The results of the study showed that the objective relief rate (ORR) reached 80% (24/30; 95% CI: 61.4% ~ 92.3%), and the disease control rate (DCR) reached 93.3% (28/30; 95% CI: 77.9% ~ 99.2%), 1 patient was completely relieved (CR). In addition, in recent years, we have also carried out some small sample research such as immune combined targeted therapy or combined with local chemotherapy irrigation.

New types of targeted drugs related to transformation: Soffinib can directly inhibit the production of tumor vascular by inhibiting VEGFR1/2/3, FGFR1, and can also reduce TAM by inhibiting CSF-1R and FGFR1, indirectly inhibit the formation of tumor blood vessels, thereby inhibiting inhibitory inhibitory Tumor proliferation can also improve tumor immunity and play a role in combined with immunoagnal coordination. Sovoni Nonic single drugs are used to treat the iridispped or metastical biliary tumor effect of the second line, which is similar to the efficacy of the similar antiovascular production drugs, and the safety is good. The tumor is also exploring, including Soffinib and Toropley Monoprum's late physical tumor Stage IB Stage IB Study (NCT03879057) have been completed, and the best dose is determined. Niche or combined chemotherapy, Soffinib combined immunotherapy in BTC's first and second -line therapy, the research results are expected.

Professor Fu Xiaohui: Gao ORR means that the tumor retracts, even if there is a space of 1mm between the tumor and the large blood vessels, the patient can change from the original "non -removal" to "removal". Therefore The important idea of ​​BTC conversion therapy, we also look forward to a targeted drug such as Sovini can play a greater role with immunotherapy.

Professor Tang Zhaohui: The current era surgeon cannot just stare at the operating knife in his hands. Instead, he should strengthen the combination of treatment methods such as drugs to play a greater role. In addition, the combination of drugs and drugs is also very important. New targeted drugs like Sovni Nini and immunotherapy can achieve a considerable effect of 1+1> 2. It can inhibit VEGFR1/2/3. Reduce TREG's activity inhibitory of T cells and NK cells; it can also reduce the shielding of T cells by inhibiting VEGFR1/2/3, FGFR1, and reducing vascular abnormalities. By inhibiting CSF-1R and FGFR1, TAM to T cells, NK cells and NK cells and The active suppression of DC cells is coordinated with immunotherapy. In addition, the role of Sovininib's anti -blood vessels can also play a role in improving the micro -environment of the tumor, and a combination plan based on Sovinib may become an important development direction in the future.

Joint treatment has become the "key to breaking the situation", and BTC treatment is worth looking forward to

Professor Fu Xiaohui: BTC treatment in the future specially requires the combination of major diagnosis and treatment centers to carry out more high -level clinical research to solve more important clinical problems. Ask the two professors how to view the future and tomorrow of BTC treatment?

Professor Shi Yinghong: Although surgery is an important means to cure BTC, the "strength" of simple surgery and the beneficiaries are limited. It is necessary to solve the problem of tumor recurrence and metastasis. It is still the top priority. In addition, the transformation treatment is also the core development direction of the future. Systematic treatment is the condition for creating surgery for more patients to create surgery. It is also the direction of our clinicians.

Professor Tang Zhaohui: The future treatment of BTC can be summarized in the six words "standard, comprehensive, and individual". Treatment, standardized treatment on this basis; "comprehensive" refers to the combination between surgical surgery, drug treatment, local treatment and other means to play a greater role; Heterogeneity leads to different clinical problems in each patient. Therefore, when choosing a treatment plan, you need to comprehensively consider multiple factors to formulate the most suitable treatment plan for patients.

Professor Fu Xiaohui: The drug treatment of BTC still has a lot of room for development. Various new treatment plans are endless. Which of them are the best solutions? Which schemes can be used for clinical issues such as new assistance/auxiliary/conversion still to be answered more forward -looking studies. In general, with the emergence of innovative drugs such as Sovininib, the future development of BTC treatment is very exciting. Expert Introduction

Professor Fu Xiaohui

Director of the Surgery and Research Office of Shanghai Oriental Hepatobiliary Surgery Hospital

Associate Professor and Deputy Chief Physician of the Two Department of Biliary Taoist Hospital of Oriental Hepatobiliary Surgery

Master from Academician Wu Mengchao, Professor Yao Xiaoping and Professor Zhang Yongjie

Visiting Scholar of Medical Center at the University of Chicago

Member member of the Biliary Tunology Group of the Chinese Medical Association Surgery Branch

Member of the Minimally Invasive Group of the Shanghai Medical Association Surgery Branch

Member of the American Cancer Surgery Association

Editorial Committee

Editorial Committee of the World Chinese Gastroenterology Magazine

In 2011, the first Shanghai Yangpu District Physician Association Excellent Clinical Physician Award

In 2016, he was rated from Yangpu District, Shanghai

Expert Introduction

Professor Tang Chaohui

The chief physician of the Xinhua Hospital of Shanghai Jiaotong University Medical College, a doctor of clinical medicine.

Deputy Chairman and Secretary -General of the Biliary Surgeon Committee of the Chinese Medical Association Surgeon Branch

Member of the Chinese Medical Association Spleen and Door Varic vein hypertension group

President of the Bethune Public Welfare Foundation Hepatobiliary Professional Committee

National Health and Health Commission Eras Expert Committee

Member of the Commission for Compassion Construction and Continuing Education Surgery Surgery

Deputy Chairman of the Hepatoboli Special Committee of the Medical Exchange Association Cross -Strait

Member of the Liver Cancer Special Committee of the China Anti -Cancer Association

Member (FACS) Member (FACS)

Councilor of the International Hepatobiliary pancreatic association China Branch

China Gastrointestinal Magazine, China Migration Cancer Magazine, Hepatology Chinese Edition, Shanghai Medical Journal, China Popular Foundation and Clinical Magazine, Practical Liver Leader of Live Liver Diseases and Chinese Liver Surgery Electronic Magazine Editorial Committee Editorial Committee

GASTROENTEROGY, Cancerlet, Surgical Endoscopy, Journal of Second Military Medical University

Visit scholar at the University of Chicago Medical Center.

Expert Introduction

Professor Shi Yinghong

Zhongshan Hospital affiliated to Fudan University

Deputy Director of Hepatology of Zhongshan Hospital affiliated to Fudan University

Deputy Director of Fudan University Institute of Liver Cancer Research

Executive Member of the China Anti -Cancer Association Tumor Micro Environment Commission

Director of the Youth Council of the Cancer Branch of the Chinese Medical Association

Deputy Leader of the Cancer Branch of the Chinese Medical Society on the Cancer Society of Tumors

Vice Chairman of the Youth Council of the Shanghai Anti -Cancer Association

Member of the Hepatic Cancer Expert Committee of the Pharmaceutical Exchange Association of Cross -Straits of the Straits

Deputy Chairman of the Youth Committee of the Haiyi Society of Hepatic Cancer Committee

Standing Committee and Deputy Director of the Standing Committee and Deputy General Director of the Organ Transplant Branch of the Sea Medical Association

Member of the Immunization Professional Committee of Organ Transplantation Physician Branch of the Chinese Physician Association

Youth Member of the Surgery Branch of China Medical Care International Exchange Promotion Association

Deputy Secretary -General of the World Chinese Physician Association Cancer Association

Reference materials:

[1]OhDY,HeAR,QinS,etal.Aphase3randomized,double-blind,placebo-controlledstudyofdurvalumabincombinationwithgemcitabinepluscisplatin(GemCis)inpatients(pts)withadvancedbiliarytractcancer(BTC):TOPAZ-1[J].DOI:10.1200/JCO.2022.40.4_suppl.378JournalofClinicalOncology40 , No.4_suppl (February01,2022) 378-378.

[2]ZhouJ，FanJ，ShiG，etal.Anti-PD1antibodytoripalimab，lenvatinibandgemoxchemotherapyasfirst-linetreatmentofadvancedandunresectableintrahepaticcholangiocarcinoma:AphaseIIclinicaltrial［J］.AnnOncol，2020，31(suppl4):260-273.

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