Editor’s Note:At the 34th Annual Meeting of the Asian Pacific Association for the Study of the Liver (APASL 2025), Professor George Lau, Chairman of Hong Kong Humanity Medical Group and Director of Humanity Medical Clinical Research Center, shared important insights on cuttingedge topics including clinical cure of chronic hepatitis B (CHB) and liver cancer prevention. With the WHO’s 2030 goal to eliminate CHB approaching, China’s CHB prevention and treatment efforts face new opportunities and challenges. In this exclusive interview, drawing on his extensive clinical experience, Professor Lau systematically outlines key breakthroughs and remaining dilemmas in the fields of CHB clinical cure and liver cancer prevention, offering valuable professional perspectives to advance China’s work in CHB and liver cancer control. 

Hepatology Digest:What are the major global advances in clinical cure of CHB at present?

Prof. Lau: Current research on CHB clinical cure focuses mainly on novel smallmolecule drugs, including siRNA and antisense oligonucleotides (ASO). But we must acknowledge that the realworld efficacy of these new therapies is still not ideal. A recent Roche trial of a new drug still required combination with interferon, which says a lot. Looking back at the history of treatment development, since lamivudine was approved in 1998 for CHB therapy, we have found that nucleos(t)ide analogues (NA) combined with longacting interferon produce significant benefits for specific patient groups — for example, patients with quantitative HBsAg below 3,000 IU/mL can achieve a clinical cure rate of over 20%.

However, new drug development still faces many practical challenges. First, the applicable population is limited: existing new drugs mainly target patients with low HBsAg levels, who are mostly over 50 years old, so treatment efficacy may be affected by age. Second, there is the issue of costeffectiveness — new drugs are expensive and inconvenient to use, making widespread adoption difficult. Most importantly, HBV can integrate into host DNA, a characteristic completely different from HCV, posing enormous difficulties for complete viral eradication.

Hepatology Digest:How can we minimize the risk of liver cancer in CHB patients to the greatest extent?

Prof. Lau: Scientific evidence clearly shows that early intervention is key. Specifically, except for special circumstances such as HBV DNA negativity, no cirrhosis, or no family history, all HBsAgpositive patients should receive antiviral therapy, which can significantly reduce liver cancer risk. At the same time, we recommend abdominal ultrasound combined with alphafetoprotein testing every six months. This protocol costs about 150 RMB and enables early detection of liver cancer, greatly improving cure rates.

Yet in practice, these effective approaches are still not fully implemented. The problems lie mainly in two areas: first, existing treatment guidelines are overly complex — for instance, strict limitations on HBV DNA thresholds should be simplified into a more actionable “treat if HBsAg positive” strategy; second, there are multiple systemic barriers in healthcare, including uneven resource distribution and lack of patient followup mechanisms. On a positive note, in my medical center, through standardized implementation of these strategies, none of the systematically managed CHB patients have died of liver cancer over the past 15 years.

Hepatology Digest:What breakthrough progress has been made in systemic therapy for liver cancer?

Prof. Lau: The biggest breakthrough in current systemic therapy for liver cancer is treatment regimens based on immune checkpoint inhibitors. The use of PD1/PDL1 inhibitors combined with antiangiogenic agents has raised the 5year survival rate of unresectable liver cancer patients from less than 5% in the past to 20%. Even more encouraging is that some patients have gained the opportunity for surgery or liver transplantation as a result.

Looking ahead, I believe we need to focus on advancing work in three areas: First, establish a nationwide liver cancer screening network, leveraging primary healthcare institutions and digital platforms. Second, build multidisciplinary collaboration mechanisms to organically integrate CHB treatment, liver cancer surveillance, and systemic therapy. Finally, optimize allocation of medical resources and make full use of China’s advanced internet infrastructure — for example, distributing medicines via ecommerce platforms and establishing online health management systems — to effectively lower healthcare costs.