Editor’s Note: Breast cancer liver metastases represent a major clinical challenge, requiring treatment strategies that balance anti-tumor efficacy with protection of liver function. At the 8th Conference on Oncology Precision Medicine and the 11th Conference on Individualized Therapy for Breast Cancer (2025 COMB), Professor Jiayu Wang of the Cancer Hospital, Chinese Academy of Medical Sciences, delivered a presentation on “Medical Treatment of Breast Cancer Liver Metastases.” Following her lecture, Oncology Frontier interviewed Professor Wang, who shared insights on the epidemiology of breast cancer liver metastases, her team’s latest research findings, strategies for protecting liver function, and her experience in individualized patient management.Epidemiology of Breast Cancer Liver Metastases
Oncology Frontier: Liver metastasis is one of the most common sites of distant spread in breast cancer and a major therapeutic challenge. Could you summarize the current epidemiology of breast cancer liver metastases?
Professor Jiayu Wang:The liver is a frequent site of metastasis for many primary malignancies. The most common primary cancers leading to liver metastases are lung cancer (27.6%), breast cancer (15.3%), prostate cancer (15.3%), pancreatic cancer (7.4%), and melanoma (7.4%) . Breast cancer is the second most common cause of liver metastases, with 25.6%–56% of patients with metastatic breast cancer eventually developing liver involvement.
At present, neither domestic nor international guidelines provide a clearly defined systemic treatment strategy specifically for breast cancer liver metastases, nor is there consensus on the optimal local treatment approach for these patients. Thus, identifying effective treatment regimens to improve outcomes in this population is crucial—not only for the prognosis of metastatic disease but also for the overall management of the primary tumor.
Advances in Targeted Therapy and Immunotherapy
Oncology Frontier:Targeted therapy and immunotherapy have achieved important breakthroughs in breast cancer liver metastases. Could you share your team’s latest research and its clinical significance?
Professor Jiayu Wang:Under the leadership of Professor Binghe Xu, our team conducted the RC48-C006 trial, a randomized, multicenter, open-label phase II/III study comparing the HER2-targeted ADC disitamab vedotin with the traditional regimen of lapatinib plus capecitabine in advanced breast cancer with liver metastases.
In the phase II stage, which included patients regardless of metastatic sites, we observed that disitamab vedotin produced favorable outcomes in the subgroup with liver metastases. Building on this, the phase III stage specifically evaluated efficacy in patients with advanced breast cancer and liver metastases. The primary endpoint was progression-free survival (PFS), as assessed by an independent review committee.
Final analysis of the phase III study showed that compared with lapatinib plus capecitabine, disitamab vedotin significantly prolonged PFS—median PFS was 9.9 months versus 4.9 months, with a 44% reduction in risk of disease progression or death (HR: 0.561, P = 0.0143). The safety profile was manageable, demonstrating that disitamab vedotin offers a new and effective treatment option for HER2-positive breast cancer patients with liver metastases.
Balancing Efficacy and Liver Function Preservation
Oncology Frontier: In treating patients with breast cancer liver metastases, liver function impairment is common. How do you balance tumor control with liver protection in clinical practice?
Professor Jiayu Wang:Liver dysfunction is frequent among patients with liver metastases, particularly in those with heavy tumor burden, as tumor infiltration severely affects hepatic metabolism. Yet these patients often require urgent systemic therapy—without anti-tumor treatment, liver function rarely improves spontaneously.
In such cases, liver damage is usually driven by tumor load, so we adjust eligibility thresholds for treatment accordingly. For patients without liver metastases, chemotherapy is generally initiated only when liver transaminases are ≤1.5× the upper limit of normal (ULN). However, for patients with liver metastases, this threshold may be relaxed to 2.5×, 3×, or in exceptional cases, even up to 5× ULN.
Whether in clinical research or daily practice, treatment criteria must be adapted for patients with both liver metastases and liver dysfunction. Decisions should weigh the potential therapeutic benefit against the risks of further liver impairment, with individualized evaluation for each case. When the balance indicates relative safety and potential benefit, treatment should proceed without undue delay.
Professor Jiayu Wang
MD, Chief Physician, Master’s Supervisor Department of Medical Oncology àCancer Hospital, Chinese Academy of Medical Sciences
