The best cancer treatment in China

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There is no “absolute best” universal solution for cancer treatment, and the choice should be based on multiple dimensions, such as the type of cancer (e.g. lung cancer, breast cancer, lymphoma, etc.), stage (early/intermediate/advanced), molecular characteristics (e.g. gene mutation, PD-L1 expression), and the patient's physical condition. and other multi-dimensional comprehensive decision-making. In recent years, China has been developing rapidly in the field of cancer treatment, and has formed an advanced system that is in line with international standards, and has realized its own innovation in some areas (e.g., targeted therapies, immunotherapy, cellular therapies), which has provided more “Chinese solutions” for patients. The following is a description of the mainstream treatment means, China's innovative breakthroughs, and individualized treatment practices:

The best cancer treatment in China

Mainstream Cancer Treatments

The “gold standard” of cancer treatment is still based on surgery, radiotherapy and chemotherapy, combined with precision means such as targeted therapy and immunotherapy. Combined with targeted therapy, immunotherapy and other precise means, a multidisciplinary comprehensive treatment (MDT) model has been formed. China has reached the international advanced level in terms of technology popularization, equipment configuration and clinical experience.

1. Surgery

Surgery is the first choice of radical treatment for early-stage solid tumors (e.g., lung cancer, gastric cancer, colorectal cancer, breast cancer). China's surgical techniques (e.g., laparoscopic/robotic minimally invasive surgery) have been synchronized with international standards, and some areas (e.g., liver cancer resection, pancreatic cancer surgery) have reached international leadership.

. Cases: for liver cancer patients with tumor diameter ≤5cm and no metastasis, the 5-year survival rate of surgical resection can reach 70%-80%; breast cancer breast-conserving surgery + radiotherapy has a local control rate comparable to that of traditional total excision, while preserving the quality of life.

2. Radiotherapy

Radiotherapy destroys the DNA of cancer cells through high-energy rays, which is suitable for inoperable early tumors (e.g. early laryngeal cancer, cervical cancer) or postoperative auxiliary removal of residual lesions. Radiotherapy equipment (e.g. linear gas pedal, proton heavy ion equipment) covers a wide range of areas in China, and technologies such as stereotactic radiotherapy (SBRT), volumetric rotational intensity-modulated radiotherapy (VMAT), etc. have been popularized. VMAT) have been popularized.

. Breakthrough: Domestic proton therapy equipment (e.g., proton therapy system of Shanghai Aipuqiang Particle Equipment Co., Ltd.) has entered the clinic, and compared with the traditional photon radiotherapy, it can accurately protect the surrounding normal tissues (e.g., children's tumors, patients with brain tumors), reduce the number of Radiation damage.

3. Chemotherapy

Chemotherapy kills rapidly dividing cancer cells with drugs, and is commonly used in middle and late-stage cancers (e.g. stomach cancer, ovarian cancer) or preoperative/postoperative adjuvant therapy. China's chemotherapy regimen is in line with international guidelines (e.g. NCCN, CSCO) and reduces toxicity through “individualized dose adjustment” (e.g. adjusting the dosage according to the patient's liver and kidney function).

4. Targeted therapy

Targeted drugs target gene mutations or proteins (e.g. EGFR, ALK, BRAF) specific to cancer cells, with remarkable efficacy and lower side effects than chemotherapy. China's targeted therapy in the fields of lung cancer, liver cancer and colorectal cancer has been on a par with the international standards, and some domestic drugs (such as ectinib and apatinib) have filled the gaps in China.

Typical: non-small cell lung cancer Typical: If EGFR 19del/L858R mutation is detected in patients with non-small cell lung cancer (NSCLC), the median progression-free survival (PFS) of third-generation targeting agent ositinib (approved in China) is up to 18.9 months; the median objective remission rate (PFS) of patients with hepatocellular carcinoma treated with lumefantrine (original Chinese drug) in combination with a PD-1 inhibitor is up to 10.7%, and the PFS of patients with hepatocellular carcinoma treated with lumefantrine (original Chinese drug) in combination with PD-1 inhibitors is up to 10.9%. inhibitor, the objective remission rate (ORR) is over 40%.

5. Immunotherapy

Immunotherapy activates the patient's own T-cells to attack cancer cells by blocking the “immune escape” signals (e.g. PD-1/PD-L1 pathway) of cancer cells. China is a global leader in the research and development and clinical application of PD-1/PD-L1 inhibitors, and a number of domestically produced drugs (e.g., karelizumab, tirilizumab) have been introduced into the health insurance program, which has significantly reduced the burden on patients.

. Breakthrough: In the field of hepatocellular carcinoma, the “T+A regimen” of domestically produced PD-1 inhibitors (such as cedirizumab) combined with targeted drugs (bevacizumab analog) has resulted in the median overall survival (OS) of patients with advanced hepatocellular carcinoma to reach 19.2 months (IMbrave150 study in China). In the field of nasopharyngeal cancer, the combination of a domestic PD-1 inhibitor (karelizumab) and chemotherapy prolonged the OS of recurrent/metastatic patients to 18.1 months (CAPTAIN-2 study).

China's “Innovative Breakthroughs” in Cancer Treatment

China has achieved global leadership in some cutting-edge areas, and has provided “China-specific” innovative solutions for cancer patients.

1. CAR-T cell therapy

CAR-T (Chimeric Antigen Receptor T-cells) genetically modifies a patient's own T-cells to accurately recognize cancer cells. China leads the world in the number of CAR-T clinical trials (accounting for more than 50% globally) and the expansion of indications, and a number of domestically produced CAR-T products have been approved for marketing.

. Cases: Fosun Kite's Archilenside (Yescarta Chinese version) for large B-cell lymphoma with an ORR of 83%; WuXi Juno's Relma-cel for relapsed/refractory large B-cell lymphomas; and Fosun Kite's Rigiorense (Relma-cel) for relapsed/refractory large B-cell lymphomas. refractory large B-cell lymphoma, with a 2-year overall survival (OS) of 54%; Keji Pharmaceutical's Zevoqui Orense (CT053) for multiple myeloma, with an ORR of more than 90% (Chinese pivotal phase II data).

2. Bispecific antibodies

Bispecific antibodies can bind to both cancer cells and T cells to enhance killing efficiency. China is a global leader in bispecific antibody R&D, with several drugs in late-stage clinical stage.

. Progress : Kangfang Biological's cardunolizumab (PD-1/CTLA-4 dual antibody) for advanced cervical cancer, with a median OS of 17.4 months (vs. chemotherapy's 13.6 months); Kangningjeri's KN046 (PD-L1 /CTLA-4 dual antibody) shows potential in non-small cell lung cancer, pancreatic cancer and other fields.

3. Cancer vaccines

Therapeutic cancer vaccines activate the patient's immune system to recognize specific cancer cell antigens, and China is currently exploring personalized vaccines in the fields of liver cancer and gastric cancer.

. Cases: Peking University's personalized tumor neoantigen vaccine (customized based on patients' tumor mutation profiles), combined with PD-1 inhibitor for advanced melanoma, initially showed the potential of prolonging progression-free survival; some hospitals have conducted clinical trials of personalized peptide vaccines for liver cancer, with good initial safety.

4. Minimally invasive interventional therapy

For small inoperable tumors (e.g. liver cancer, lung cancer, kidney cancer), China has widely carried out radiofrequency ablation, microwave ablation, cryoablation, etc., which are less traumatic, faster recovery, and comparable to surgery in terms of curative effect.

. Advantage: If the tumor diameter of liver cancer patients is ≤3cm, the 5-year survival rate of ablation treatment is close to that of surgical resection (about 50%-70%), and the operation can be repeated.

Chinese medicine relieves pain and improves the quality of life in cancer treatment.

Chinese medicine is not a “radical cure” for cancer, but it has unique value in reducing the side effects of radiotherapy, regulating immunity and improving symptoms, and has been included in the Chinese Society of Clinical Oncology (CSCO). It has been included in the “Chinese Society of Clinical Oncology (CSCO) Guidelines for Tumor Treatment”.

Main application scenarios

. Reducing the toxicity of radiotherapy: For example, herbal medicines such as Astragalus and Codonopsis can alleviate bone marrow suppression (boosting white blood cells); Ginger Semen and Bamboo Roots can reduce nausea and vomiting; Salviae Miltiorrhizae and Rhizoma Ligustici Chuanxiong can improve numbness of hands and feet (peripheral neuropathy) induced by chemotherapy.

. Regulate immune function: Ganoderma lucidum spore powder, Cordyceps sinensis, etc. can assist in boosting T-lymphocyte activity; Fuzheng-type formulas (e.g., Si Jun Zi Tang, Ba Zhen Tang) can improve the patient's symptoms of fatigue and loss of appetite.

. Adjuvant therapy: For pain, insomnia and anxiety of advanced cancer patients, external application of Chinese medicine (such as pain relief cream) and acupuncture can improve the quality of life.

Note: Chinese medicine should be directed by a doctor specializing in combined Chinese and Western medicine and oncology in a regular Chinese medicine hospital.

The key to individualized treatment: how to choose the “best-fit” option?

The “best” plan for cancer treatment should be formulated through multidisciplinary consultation (MDT), and the core considerations include:

1. Cancer type and stage: Surgery is the mainstay in early stage, and systemic therapy (target/immunity) combined with local therapy (radiotherapy/intervention) is the mainstay in advanced stage.

2. Molecular features: genetic testing (e.g., NGS) to clarify whether there are driver mutations (e.g., EGFR, ALK), PD-L1 expression level, TMB (tumor mutation load), to guide the choice of targeted/immunotherapy.

3. Physical condition of patients: Elderly patients or patients with underlying diseases (e.g., heart disease, diabetes) need to adjust the dose of drugs or choose a low-toxicity regimen (e.g., targeted therapy instead of chemotherapy).

4. Economy and accessibility: Some new drugs (e.g., imported targeted drugs, CAR-T) have higher costs, which need to be combined with health insurance policies (e.g., multiple domestic PD-1s will be included in health insurance in 2023) and commercial insurance options.

Summarizing: “Advantages and Future” of Cancer Treatment in China

China has formed a two-wheel-drive model of “international synchronization + independent innovation” in the field of cancer treatment:

. International synchronization: Surgery, radiotherapy, targeted/immunotherapy and other technologies are in line with international guidelines, and patients can obtain the latest global therapies at the same time; .

. Self-innovation: CAR-T, dual-antibodies, domestic targeted drugs and other fields are leading the world, reducing treatment costs and providing more choices at the same time.

In the future, with the breakthroughs in liquid biopsy (early screening), AI-assisted diagnosis, gene editing (e.g., base editing for hereditary cancers) and other technologies, China's cancer treatment will move forward towards “precision, individualization, and early stage”. In the future, with the breakthrough of liquid biopsy (early screening), AI-assisted diagnosis, gene editing (e.g., base editing for hereditary cancer) and other technologies, China's cancer treatment will move toward “precision, individualization, and early detection”, which will bring better survival and quality of life to patients.

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