‘World’s first’ treatment said to reverse stage-four liver cancer

Summary

Researchers at the University of Hong Kong have developed a 'reduce and remove' strategy that has successfully reversed stage four liver cancer in some patients. The innovative treatment combines regional chemotherapy, stereotactic beam radiotherapy, and immunotherapy, resulting in a 40% complete response rate and enabling surgery in an additional 12% of cases. A recent groundbreaking case involved shrinking an 18 cm tumor to 1.2 cm, leading to a liver transplant and long-term survival prospects for the patient.

Takeaways

• 🔬 Liver cancer is the third deadliest form of cancer worldwide.
• 🌟 Researchers at the University of Hong Kong have developed a 'reduce and remove' strategy to treat stage four liver cancer.
• 💡 The treatment combines regional chemotherapy, stereotactic beam radiotherapy, and immunotherapy.
• 📉 The strategy has achieved a 40% complete response rate in imaging studies, with an additional 12% of patients having their tumors shrink enough for surgery.
• 🏥 A groundbreaking case involved an 18 cm tumor that invaded major blood vessels, which was reduced to 1.2 cm after treatment, allowing for liver transplantation.
• 🔍 The standard treatment for liver cancer is surgery, but only about a third of patients are eligible due to the severity of their condition.
• 🆕 The 'reduce and remove' strategy has increased the surgery eligibility rate from the traditional 10% to up to 70% response rate, with half of those having a complete response.
• 📊 Stage four liver cancer typically has a 6 months to 1 year survival rate of about 30-40%.
• ⏳ The patient in the case study has been cancer-free for almost four months since the operation.
• 🌱 The treatment was first tried in 2017 and a Phase 2 clinical trial was conducted from 2019 to 2021, showing promising results even during the COVID-19 pandemic.
• 📈 It's estimated that 400 to 600 liver cancer patients in Hong Kong could benefit from this treatment strategy annually.

Q & A

What is the significance of the 'reduce and remove' strategy in treating liver cancer?

The 'reduce and remove' strategy is groundbreaking as it combines three different forms of treatment to reverse stage four liver cancer, potentially shrinking it to stage one. This multimodality treatment approach includes regional chemotherapy (The TACE), stereotactic beam radiotherapy (SBRT), and immunotherapy, leading to a higher response rate and the possibility of surgical removal of the tumor.

How does the multimodality treatment strategy work in the 'reduce and remove' approach?

The multimodality treatment strategy in the 'reduce and remove' approach involves a combination of regional chemotherapy (TACE), highly concentrated radiation (SBRT), and immunotherapy. This combination aims to kill off tumor cells and, in some cases, reduce the tumor size to a point where it can be surgically removed.

What was the condition of the patient in the latest groundbreaking case?

The patient in the latest case had an 18 cm tumor that replaced the entire left liver and invaded blood vessels, including the left and right portal veins and the main trunk, indicating a T4 stage four liver cancer. His liver function was also quite bad, making standard treatment options limited.

What was the impact of the 'reduce and remove' strategy on the patient's tumor size?

The 'reduce and remove' strategy led to a dramatic reduction in the patient's tumor size. The tumor, initially 18 cm, was reduced to 1.2 cm after the treatment, making it possible to consider liver transplantation.

What is the typical treatment for liver cancer, and how does the 'reduce and remove' strategy differ?

The standard treatment for liver cancer often involves surgery to remove the tumors, which provides the best outcome. However, only about a third of patients are eligible for surgery. The 'reduce and remove' strategy aims to increase the number of patients who can undergo surgery by combining different treatments to reduce tumor size and improve liver function.

What is the survival rate for stage four liver cancer patients who do not undergo surgery?

For stage four liver cancer patients who do not undergo surgery, the 5-year survival rate is approximately 30%. The 'reduce and remove' strategy aims to improve these odds by making surgery a viable option for more patients.

What is the typical mortality rate for stage four liver cancer?

The typical mortality rate for stage four liver cancer is quite high, with a survival time of 6 months to one year and a survival probability in the region of 30 to 40%.

How long has the patient in the latest case been cancer-free after the treatment?

The patient in the latest case has been cancer-free for almost four months since the operation, which was performed in August.

How many new cases of liver cancer are diagnosed each year in Hong Kong?

In Hong Kong, there are over 1,700 new cases of liver cancer diagnosed each year, making it the fifth most common and the third most deadly type of cancer.

What is the potential reach of the 'reduce and remove' strategy in terms of helping liver cancer patients in Hong Kong?

Considering the number of patients diagnosed with liver cancer each year in Hong Kong, it is estimated that about 400 to 600 patients could benefit from the 'reduce and remove' treatment strategy annually.

How does the 'reduce and remove' strategy fit into the current treatment landscape for liver cancer?

The 'reduce and remove' strategy offers a new approach by combining different treatments to increase the response rate and the possibility of surgical intervention. It is particularly beneficial for the two-thirds of patients who are not candidates for surgery under standard treatment protocols.

Outlines

00:00

🌟 Breakthrough in Liver Cancer Treatment

Researchers at the University of Hong Kong have developed a revolutionary 'reduce and remove' strategy for treating stage four liver cancer. This multimodality treatment combines regional chemotherapy (The TACE), highly concentrated radiation (SBT or stereotactic beam radiotherapy), and immunotherapy. The treatment has shown a 40% complete response rate in imaging studies, with an additional 12% of patients experiencing tumor shrinkage sufficient for surgery. Professor Albert Chan, co-leader of the research, discusses a groundbreaking case where an 18 cm tumor was reduced to 1.2 cm, enabling a liver transplant. This approach significantly increases the likelihood of surgery for patients who would otherwise have limited treatment options.

05:01

📈 Liver Cancer Statistics and Treatment Development

In Hong Kong, over 1,700 new cases of liver cancer are diagnosed annually, making it the third deadliest cancer type. Typically, only a third of these patients are eligible for surgery, which offers the best prognosis. The remaining patients face a 30% five-year survival rate without surgery. The 'reduce and remove' strategy has been in development since 2017, with a Phase 2 clinical trial initiated in 2019. Despite the challenges of the COVID-19 pandemic, the trial concluded in 2021, demonstrating the potential to treat up to 600 patients annually. The treatment's outpatient nature was particularly advantageous during the pandemic, allowing for continued care with minimal hospital stays.

Keywords

💡Liver Cancer

Liver cancer is a malignant tumor that originates in the liver and is the third deadliest form of cancer globally. In the video, the theme revolves around a breakthrough treatment for this disease. The script discusses the severity of stage four liver cancer and the innovative 'reduce and remove' strategy developed by researchers at the University of Hong Kong to combat it.

💡Reduce and Remove Strategy

This is a novel multimodality treatment approach mentioned in the script, which combines regional chemotherapy, stereotactic beam radiotherapy, and immunotherapy to combat stage four liver cancer. The strategy is groundbreaking as it has shown to shrink tumors significantly, allowing for surgical removal or even complete response in some cases.

💡Regional Chemotherapy

Regional chemotherapy, also referred to as 'The Taste' in the script, is the first component of the 'reduce and remove' strategy. It involves administering chemotherapy directly to the liver, targeting cancer cells while minimizing side effects on the rest of the body. This treatment is crucial for the initial reduction of tumor size.

💡Stereotactic Beam Radiotherapy (SBT)

SBT is a highly concentrated form of radiation therapy used in the 'reduce and remove' strategy. It is precise and delivers a high dose of radiation to the tumor while sparing surrounding healthy tissue. The script highlights its role in killing off tumor cells after regional chemotherapy.

💡Immunotherapy

Immunotherapy is the third component of the treatment strategy discussed in the script. It involves stimulating the patient's immune system to recognize and attack cancer cells. Administered four weeks after SBT, it is part of the protocol that has led to a significant response rate in treated patients.

💡Complete Response

A complete response in the context of cancer treatment refers to the disappearance of all signs of cancer, as seen on imaging studies. The script mentions that about 40% of patients receiving the 'reduce and remove' strategy had a complete response, indicating the treatment's effectiveness.

💡Tumor Shrinkage

Tumor shrinkage is a reduction in the size of a tumor, often an indicator of treatment effectiveness. The script provides an example of a patient whose tumor shrank from 18 cm to 1.2 cm after the treatment, demonstrating the dramatic impact of the 'reduce and remove' strategy.

💡Liver Transplantation

Liver transplantation is a surgical procedure to replace a diseased liver with a healthy one. In the script, it is mentioned as a solution for a patient with a severely damaged liver after the tumor had shrunk, highlighting an additional treatment option made viable by the 'reduce and remove' strategy.

💡Alpha Fetal Protein (AFP)

AFP is a protein produced by the liver and is often elevated in the blood of individuals with liver cancer. The script describes a case where the AFP levels dropped dramatically from over 100,000 to double digits after treatment, indicating a positive response to therapy.

💡Stage Four Liver Cancer

Stage four liver cancer indicates a very advanced stage of the disease, where the tumor may have spread outside the liver or invaded major blood vessels within it. The script discusses the poor prognosis associated with this stage and how the 'reduce and remove' strategy has improved outcomes for some patients.

💡Survival Rate

Survival rate refers to the percentage of patients who are alive for a certain period after diagnosis or treatment. The script contrasts the typically low survival rate for stage four liver cancer patients with the improved outlook for those who have responded to the 'reduce and remove' strategy.

Highlights

Researchers at the University of Hong Kong have developed a groundbreaking treatment for stage four liver cancer known as the 'reduce and remove' strategy.

The 'reduce and remove' strategy combines regional chemotherapy, stereotactic beam radiotherapy, and immunotherapy to combat liver cancer.

Approximately 40% of patients treated with this strategy showed a complete response with no visible tumor cells on imaging.

An additional 12% of patients experienced significant tumor shrinkage, allowing for surgical removal.

A recent case involved an 18 cm tumor invading major blood vessels, considered inoperable under standard treatments.

The patient's tumor and liver were successfully removed through liver transplantation following the 'reduce and remove' treatment.

The treatment strategy has increased the surgery eligibility rate for liver cancer patients from 10% to 70%.

Stage four liver cancer typically indicates tumors have spread outside the liver or invaded major vessels within it.

The mortality rate for stage four liver cancer is approximately 30 to 40% within six months to one year.

Liver cancer is the third most deadly cancer in Hong Kong, with over 1,700 new cases diagnosed annually.

Only a third of liver cancer patients are eligible for surgery, leaving two-thirds to seek alternative treatments.

The 'reduce and remove' strategy was first tested in 2017 with promising results, leading to a Phase 2 clinical trial.

The treatment can mostly be conducted as an outpatient service, which was advantageous during the COVID-19 pandemic.

An estimated 400 to 600 liver cancer patients in Hong Kong could benefit from this treatment strategy annually.

The treatment's success has been observed in dozens of patients, with significant response rates.

Professor Albert Chan, co-leader of the research, discusses the innovative approach and its implications for liver cancer treatment.

Transcripts

liver cancer is the third deadliest form

of the disease worldwide but researchers

at the University of Hong Kong have

found a way to reverse stage four liver

cancer with a groundbreaking new

treatment known as the reduce and remove

strategy the hku team said this would be

the first in the world to shrink stage

four liver cancer to stage one to tell

us more we have the co-leader of the

research Professor Albert Chan in our

studio today just to get us started

people often get really excited when

they see or hear about a cure for cancer

is that what this is and can you just

tell us more about how the reduce and

remove strategy works well basically we

are using a multimodality treatment

strategy we're combining three different

forms of treatment the first one is a

local Regional chemotherapy called The

Taste and followed by that we use a very

uh highly concentrated radiation called

the SBT or stereotactic beam

radiotherapy and that would kill off the

tumor cells and four weeks later on we

add the immunotherapy so over the last

four or five years we have been

conducting this study and we do see that

about 40% of our patients receiving this

treatment they had a complete response

on imagings that means when they did an

MRI scan or P scan there was absolutely

no optic in the tumor so the tumor cells

basically is radiologically it's

completely dead and additional 12% of

these patients the tumor actually shrunk

in size and we were able to perform

surgery and remove the tumors can you

bring briefly describe this latest case

that you have and why it was so

groundbreaking so this patient came to

see me in November 2022 at that time his

abdomen was actually quite bloated and

on the Imaging we found that was an 18

cm tumors actually replacing the entire

left liver and more importantly the

tumor invaded into the blood vessels

into the left portal vein the right

portal vein even the main trunk so

basically in essence this was from the

tumor perspective this was a T4 stage

four liver cancer and in current

practice because his liver function is

quite bad there was actually no

standardized treatment for this kind of

advanced disease so at that time it was

pretty hopeless for that patient and he

came to see me and we sat down and we

discuss what about you know we try go

for this uh clinical trial treatment and

in the end we started this treatment in

20122 and over the next 6 months we saw

very dramatic effect not just the tumor

shrunk in eyes but the tumor Markus the

alpha fetal protein when it first

started it's over 100,000 and it came

gradually down to double digits and

because the tumor has significantly

shrunk in size and he still got a very

serotic liver so that time we came to

the idea that you know we're going to go

for remove of the tumor and because the

liver was actually serotic so he could

not have any surgery to remove the tumor

and in order to do so we had to remove

the tumors and also the liver so that's

why it came the idea we were thinking

about liver

transplantation fortunately he had a

very supportive family you know his sons

his his daughter and his wife they all

along look after this patient very well

and in fact when we mentioned about the

possibility of liver transplantation his

son without hesitation just step forward

and that's how it all happened in the

end so for someone who's typically uh

has for someone who typically has liver

cancer what sort of treatments are

normally available to them well actually

the standard treatment for all Li

cancers if we can perform surgery to

remove the tumors that would give the

best outcome for these patients but

unfortunately we know that about a third

of these patients they were able to

receive surgery so that means the

remaining twoth thirds they can either

go for systemic treatment or other local

treatment but we know that without any

surgery the 5e survival rate for these

type of patients is actually about 30%

so that's why because when we're able to

perform surgery the outcome is so much

better we are as surgeons we are

thinking of innovative ways to improve

the chance of these patients to receive

surgery so how does this uh this reduce

and remove strategy improve the

likelihood of them being able to get

well this significantly improved the

chance of our patients to receive

surgery like in the past they can either

receive Standalone uh radiation or

Standalone immunotherapy but the

response rate of a complete response is

rather low we are talking about 10% Max

but with a ation of these Tri modality

treatment strategies we were able to

increase the response rate up to 70% and

within the 70% about half these patients

actually had a complete response and an

additional 12 patients percent of

patients they were able to receive

surgery so when we talk about stage four

cancer stage four liver cancer what does

that usually mean well stage four

basically means either the tumors have

spread outside the liver to the lung to

the bones to the lymph nodes or inside

the liver the tumor has actually invaded

to all the major uh vessels and there

are multiple tumors replacing the liver

these are we called a very late stage

stage four liver cancer and what is the

typical mortality rate when someone

reaches the stage it's really depending

on the stage obviously for stage one

cancer the mortality rate is much lower

but for stage four cancer we are talking

about a 6 months to one year survival

probably in the region about 30 to 40%

and so for this latest case that you had

presented what was his survivability did

you guys estimate that well at that time

at the first presentation with that kind

of extensive tumor involvement and po

lier function he was predicted to have a

survival of about 6 months to 12 months

and now with this treatment we were able

to shrink the tumors and then receive

the liver transplantation and after we

remove his own liver and We examined the

own liver the vial tumor was only 1.2 CM

so we were we're talking about shrinking

an 18 cm tumor to 1.2 CM tumors so we're

basically looking for long-term survival

for this patient so how long has he been

cancer free now well the operation was

done in August so it's just almost like

four months and obviously the future

plan is to keep surveillance for this

patients S3 performance to perform

imagen for surveillance and can you just

give us a few more details about liver

cancer in general so approximately how

many people are diagnosed with it each

year now it in Hong Kong we do see about

over 1,700 new cases of liver cancer it

is ranked the fifth most common cancer

in Hong Kong and also the third most

deadly uh cancer types and as I said

over this 1,700 patients only a third of

these patients they were able to receive

surgery and the remaining two3 of the

patients they have to go for other forms

of treatment so can you just kind of

walk us through how long you guys have

been developing this cancer treatment

well our first index patient was

actually we did this first patient in

back in

2017 and because of this at that time we

also had a patient with stage four

cancer and with this uh Innovative

treatment all the cancer disappeared and

he remained alive till this St and at

that time with such promising outcome we

came up with designed this Phase 2

clinical trial and we started in

2019 and remember that that was just the

beginning of the covid era and this

brought us through the covid era and we

finish the trial uh in 2021 one of the

most uh I would say the advantage of

this regime is majority of this

treatment they can be conducted as an

outpatient setting so apart from the

first treatment that is the local

Regional treatment the patient needs to

stay overnight the other two forms of

treatment the radiations the

immunotherapies they don't need to stay

overnight so they only come in during

the day receive the treatment and then

they go home so this is especially

convenient for patients during the covid

era when we were trying to reduce the

impatient Hospital State demand and that

basically allow us to treat a lot of

patients while we were very tight in bed

during the co era as you said this

treatment's worked with you've you've

done it on dozens of people where

they've had a successful uh response

rate to it um in terms of wider uh

distribution let's say what percentage

of liver cancer patients could this

actually help treat yes well as I said

we do see about 1,700 new cases of liver

cancer each year in Hong Kong

considering that about uh 500 patients

they can receive surgery and we are left

with another 1,200 patients so we're

very quite cautious in terms of the

estimation of this numbers and we were

expecting about 400 to 600 patients each

year can benefit from this uh treatment

strategy wow I really hope the best of

success then as this continues to move

forward thank you a lot Professor Chan

for being here with us today thank

you