Professor Dai Chaoliu: Immune combined with anti -vascular production treatment may become the main force of advanced liver cell carcinoma treatment

*For medical professionals for reading reference

The mechanism is collaborative, and the beads are combined.

Liver cancer is one of the common digestive system malignant tumors worldwide, and my country is the hardest hit area of ​​liver cancer. According to data released by the World Health Organization International Cancer Research Agency (IARC), in 2020, the number of new and death cases in my country and the number of death cases in China are respectively. 45.3%and 47.1%of the world's. In recent years, hepatocytal carcinoma (HCC) system treatment has made breakthrough progress, especially the treatment plan represented by immune examination point inhibitors (ICI) has broken the single treatment structure of molecular targeted drugs, and immunotherapy combined with antibodial generic production The strategy of targeted therapy shows satisfactory effects [2].

At present, Professor Dai Chaoliu of Shengjing Hospital affiliated to China Medical University is led a study to explore the effectiveness and safety of Enshley Mipide combined with Lumoninib to treat advanced HCC. Professor Dai was invited to discuss the purpose and original intention of the study, as well as the current status of liver cancer diagnosis and treatment of liver cancer.

Suddenly protruding

Immunotherapy injects newborn for medium and advanced liver cancer therapy

Liver cancer is a malignant tumor that seriously affects human health in the digestive system. It is also a faster incidence and mortality growth, which can greatly threaten crowd's health and life. In 2020, the number of new hair cancer and death cases in my country reached 410,000 cases and 390,000 cases. [1,3]. Studies have shown that compared with many or regions such as Europe, the United States, Japan and South Korea, the average age of liver cancer patients in my country is lower [4].

Professor Dai said that the current healing liver cutting and liver transplantation are the main means for the treatment of radical treatment of liver cancer [5]. Due to primary liver cancer hidden and strong invasion, early lack of typical clinical symptoms and difficult to find, 70 70, 70 %-80%of patients are already in the middle and late stages at the initial diagnosis, less than 20%of patients who can receive surgical resection, and the tumor recurrence rate of tumor recurrence is as high as 50%-70%after liver cancer surgery. Only 14.1%[6,7].

In recent years, immunotherapy has become another new tumor treatment method after surgery, chemotherapy, radiotherapy, and targeted therapy. Immunotherapy drugs represented by PD-1/PD-L1 inhibitors have set off a research wave in the field of liver cancer. Some clinical studies have confirmed that PD-1/PD-L1 inhibitors single drug or combined treatment can extend the survival of patients with advanced liver cancer [8-13]. At present, the "China Clinical Oncology Society (CSCO) Primary Liver Cancer Diagnosis and Treatment Guidelines 2022" has recommended a variety of immune combined treatment plans for advanced HCC first -line treatment, and some of them have grade II recommendations.

Professor Dai pointed out that there are a large number of patients with liver cancer in my country, and a large number of clinical cases show that immunotherapy combined with targeted therapy or other local treatment methods can bring good effects to patients. Some patients with mid -to -advanced liver cancer who have lost surgery opportunities can make the tumor volume significantly reduced and successfully transformed by receiving simplicity or joint treatment of immunotherapy. Immunotherapy will have a wider application prospect in the field of liver cancer treatment in the future.

Union

Immune combined with anti -vascular production treatment may play the effect of "1+1> 2"

The research led by Professor Dai aims to evaluate the effectiveness and safety of Ervolitab's combined local advanced or metastatic HCC for the irrevocable local advanced or metastatic HCC. The main ending of the study is the total survival period of the patient (OS). Tolerance [including adverse events (AE) and the incidence of severe adverse events (SAE), AE/SAE causes the incidence of treatment to terminate]. Professor Dai introduced that the reason why this study was conducted and chose the "Ervolimab to resist the combination of lumininib". The main reason is that immunotherapy is a new therapy different from traditional treatment methods, which can produce a variety of tumors. A good effect brings better survival benefits to tumor patients. Among them, liver cancer is one of the effective tumors of immunotherapy. IMBRAVE150 Study [9], Keynote 524 Study [10], Orient‑032 Study [11] and Rescue Study [12,13] confirmed that immunotherapy combined with antibodial antibodial antibodies Det targeted therapy can further improve the survival of HCC patients.

PD-1 is one of the molecules of immune examination points, which can be expressed on the surface of the activated T lymphocytes. Under normal physiological conditions, PD-1 induces expression after t-cell activation, and then combines PD-L1 on the surface of the cell on the surface of the cell to suppress T cell activity, induce immune tolerance, and prevent autoimmune diseases from occurring [14].

Studies have shown that there are PD-L1 in a variety of physical tumor cells. After combining PD-1 on the surface of the T cells, inhibit T cell proliferation and activation, reduce cytokine secretion, and cause T cells to lose tumor killing function [14,15],,,,], As a result, "immune escape". At the same time, most physical tumors have abnormal growth of blood vessels, which also helps the occurrence of "immune escape" [16].

Therefore, antemlodia production drugs and PD-1/PD-L1 inhibitors can jointly act on tumor micro-environment, reshape tumor vascular micro-environment and immune microcimply environment, transform the immunosuppressive state into immune promotion state, increase T cell to tumor to tumor The infiltration of the coordinated anti -tumor of "1+1> 2" [16,17].

Compared with conventional PD-1/PD-L1 inhibitors, Envoli Mipide has a unique advantage. It maintains the advantages of high-effect and safety of PD-L1 antibody drugs, and has small molecular weight, high affinity, stability, stability, stability Good and convenient characteristics of subcutaneous injection. Therefore, it is expected that this study can obtain good clinical data and add a new evidence to the clinic, Professor Dai added.

Ren Daoyuan

There are still many problems that are not solved in liver cancer treatment

Although there have been many new progress in the field of liver cancer treatment, there are still many clinical needs that have not been met, and there are still many problems that need further exploration and research in the future. In this regard, Professor Dai pointed out:

""

Immunotherapy and anti -vascular generation targeted therapy have a unique synergy advantage. These two systemic systemic treatment methods can effectively improve the micro -environment of patients with liver cancer and have good safety. The field is indispensable for treatment, and how to find a better combination of the efficacy in many PD-1/PD-L1 inhibitors and antiovascular generating drugs is the key to future exploration.

In addition to the treatment of systemic systems, the treatment of liver cancer also includes local treatment methods such as radiotherapy, ablation, and arterial chemotherapy embolism (TACE). At present, research has confirmed that the joint treatment of systemic treatment can significantly improve the benefits of patients' survival. The future may be in the future. Based on this, he found better solution to liver cancer treatment.

At this stage, the early screening of liver cancer diagnosis in my country still needs to be further strengthened. Most patients have missed the opportunity to receive surgical resection, and patients who have been treated with surgical resection have high recurrence and metastasis risk. Therefore, for patients with liver cancer patients, patients with liver cancer patients New assisted and auxiliary therapy has a very important role, and immunotherapy is also promising in this.

In addition, it is well known that immunotherapy is not able to have a good effect on all patients. Some patients are not sensitive to immunotherapy. What is the mechanism of action? It needs further explore by tumor workers. In addition, how to judge whether patients can obtain excellent results through immunotherapy are also important for precision treatment of liver cancer.

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Expert Introduction

Professor Dai Chao

Doctor of Medicine, Professor, Chief Physician, Director of Hepatobilia and Sleeper Surgery, Shengjing Hospital affiliated to China Medical University, doctoral tutor

Deputy Chairman of the Standing Committee of the Chinese Medical Association Standing Committee of the Standing Committee of the Chinese Physician Association

Member of the Standing Committee of the Liver Cancer Professional Committee of the China Anti -Cancer Association, a member of the Liver Surgery Group of the China Surgery Association, a member of the Liver Cancer Team of the Chinese Oncology Society, and a member of the Liver Cancer Studies Group of the Chinese Liver Society

Standing Committee Member of the Liver Professional Committee of the Chinese Medical Association Surgery Branch, Standing Committee Member of the MDT Professional Committee of the Chinese Medical Association Surgery Branch, Standing Committee Member of the Chinese Physician Association's laparoscopic liver removal promotion expert committee, member of the Chinese Physician Association Surgery Branch, member of the Baldo Professional Committee, the Chinese Medical Association Anorectal Physician Branch Tumor Transfer of Tumor Transfer Professional committee member

Council member of the China Branch of the China Branch of the International Hepatobiliary and pancreas surgery

The Standing Committee of the China Medical Care International Exchange Promotion Association of the Large -intestine Cancer Hypotherapy Professional Committee, the Standing Committee of the Soft Tumor Tumor Branch of the China Medical Care International Exchange Promotion Association, a member of the Professional Committee of the China Medical Care International Exchange Promotion Association, and a northern liver cancer expert of the China Medical Care International Exchange Promotion Association Member of the Standing Committee of the Committee of the Committee of the China Research Hospital Society

Deputy Chairman of the Cancer Prevention and Treatment Expert Committee of the Medical and Health Exchange Association Cross -Strait

Members of the Department of Health Cancer Standardized Therapy for Liver Cancer, Standing Member of the Liaoning Medical Association Surgery Branch, Chairman of the Liaoning Anti -Cancer Association Liver Cancer Professional Committee

Chairman of the Liaoning Life Science Society and Digital Medicine Branch

International and Asia -Pacific Optimism and pancreas association members

references

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