‘World’s first’ treatment said to reverse stage-four liver cancer
Summary
TLDRResearchers 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
🌟 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.
📈 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.
Mindmap
Keywords
💡Liver Cancer
💡Reduce and Remove Strategy
💡Regional Chemotherapy
💡Stereotactic Beam Radiotherapy (SBT)
💡Immunotherapy
💡Complete Response
💡Tumor Shrinkage
💡Liver Transplantation
💡Alpha Fetal Protein (AFP)
💡Stage Four Liver Cancer
💡Survival Rate
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
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