Editor’s Note: In recent years, breast cancer treatment in China has undergone a remarkable transformation, from drug accessibility to treatment paradigms, aligning more closely with global standards. At the 2024 SIBCS conference, Dr. Qiang Liu from Sun Yat-sen Memorial Hospital, Sun Yat-sen University, delivered an insightful presentation on “Major Clinical Trial Achievements in China’s Breast Cancer Treatment,” highlighting significant advancements in the field. Following the conference, Oncology Frontier interviewed Dr. Liu, who noted the increasing prominence of China’s original clinical research on the global stage. He pointed out that China is no longer simply following international developments but is now keeping pace, and in some areas, even leading, providing new hope for breast cancer patients worldwide.

Dr. Liu also shared the unique challenges faced by young breast cancer patients in China and the strategies to address them. He spearheaded the establishment of China’s first expert consensus on young breast cancer patients and launched the “Young Breast Cancer Expert Clinic” initiative, significantly improving outcomes for this patient population. Additionally, he discussed the application of precision therapy in breast cancer treatment, emphasizing the importance of individualized approaches.

Q1. Oncology Frontier: In your presentation on “Major Clinical Trial Achievements in China’s Breast Cancer Treatment,” could you provide a brief overview of your talk and comment on the international recognition and impact of these achievements? How have they shaped global breast cancer treatment strategies?

Dr. Qiang Liu: Over the past few years, there have been substantial changes in breast cancer treatment, with more and more original clinical research conducted in China, advancing the overall progress in diagnosis and treatment. Chinese patients have greatly benefited from these developments. I remember when I first returned to China in 2011, most patients had very limited access to clinical drugs, lagging at least 10 years behind Europe and the United States. Now, we see that more drugs are being approved almost simultaneously in China and abroad, meaning that the treatment strategies for Chinese breast cancer patients are now in sync with international standards.

In the last decade, we’ve also seen an increasing presence of China’s original drugs and therapies on the international stage. We are transitioning from merely following to keeping pace, and even leading in certain areas. This is a blessing not only for Chinese patients but also a great achievement for Chinese medical professionals.

Q2. Oncology Frontier: You led the development of China’s first expert consensus on young breast cancer patients and initiated the nationwide “Young Breast Cancer Expert Clinic.” What substantial improvements have these initiatives brought to young breast cancer patients, and what are your future plans?

Dr. Qiang Liu: Compared to Western countries, Chinese breast cancer patients have an earlier median age of onset (about 45–49 years), resulting in a higher proportion of young breast cancer patients in China. Young breast cancer has its unique characteristics: First, there is a higher genetic risk among these patients. Second, many of them have fertility needs, making breast-conserving surgery and ovarian protection more critical. Third, young breast cancer patients have a higher risk of recurrence and longer survival, leading to higher expectations for quality of life.

To standardize and optimize the diagnosis and treatment of young breast cancer in China, the Young Breast Cancer in China (YBCC) Academic Committee, comprising 137 experts from breast surgery, oncology, radiotherapy, gynecology, and reproductive medicine, conducted in-depth discussions on clinical issues and established the Young Breast Cancer Expert Consensus (2022) (YBCC Consensus). This consensus provides decision-making guidance and research directions for young breast cancer patients in China.

Based on the YBCC Consensus, the first “Young Breast Cancer YBCC Expert Clinic” was launched in March 2023 at Sun Yat-sen Memorial Hospital, bringing hope to young breast cancer patients across China. The expert clinic has since expanded to over a dozen hospitals nationwide, providing assistance to more patients.

Despite improvements in the treatment landscape for young breast cancer patients in China, many clinical challenges remain. On December 27–28, 2024, the second Young Breast Cancer Expert Consensus Conference will be held, where we will delve into more clinical issues. Topics for discussion include: When should young women start screening? What methods should be used? Should BRCA mutation carriers without a family history undergo prophylactic contralateral mastectomy? At this year’s conference, we will also introduce a database on the pathogenicity of BRCA mutations, which we hope will offer better diagnostic and therapeutic options for patients. With this conference, we aim to further improve clinical outcomes and ensure better quality of life for young breast cancer patients.

Q3. Oncology Frontier: With advances in genomics and molecular biology, precision therapy is becoming more prevalent in breast cancer treatment. Could you share some insights into how precision therapy is being applied to breast cancer patients? How do you approach developing the optimal treatment plan based on individual patient characteristics?

Dr. Qiang Liu: For early-stage breast cancer, the goal is a cure, so patients should receive standardized treatment first. For advanced breast cancer patients, the goal is to prolong survival and improve quality of life, which is where precision therapy plays a crucial role. However, this treatment model does not negate individualized treatment. For instance, based on the molecular subtype and tumor size of early-stage breast cancer patients, we can determine whether neoadjuvant therapy is needed. We can then design personalized adjuvant therapy plans based on the response to neoadjuvant treatment, aiming to achieve higher cure rates for patients at medium to high risk.

It’s essential to accurately identify which patients should receive intensified treatment and which should have treatment de-escalation. This is a key focus for future research, and I believe we are close to achieving major breakthroughs in these areas. In the past few years, we have conducted several studies on circulating tumor DNA (ctDNA), and one of our team’s upcoming publications explores the systemic tumor burden in breast cancer patients. This study seeks to identify which patients require escalated treatment and which can have treatment de-escalation, thereby enhancing the precision of breast cancer therapy.

Overall, for early-stage breast cancer, we aim to tailor treatments by assessing the patient’s initial response to tumor therapy, minimizing unnecessary side effects and costs. For advanced breast cancer, targeted therapy based on previous treatment response, recurrence drivers, and drug resistance markers will lead to better outcomes.

Dr. Qiang Liu

• Professor, Chief Physician, Researcher, PhD Supervisor
• Director of the Department of Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
• Executive Vice President of Yixian Breast Cancer Hospital, Director of the Breast Cancer Center, and Director of the Department of Breast Surgery
• Member of the ESO-ESMO International Consensus Group on Young Breast Cancer
• Executive Committee Member and Deputy Secretary-General of the Breast Cancer Committee of the Chinese Society of Clinical Oncology
• Executive Committee Member of the Breast Cancer Committee of the Chinese Anti-Cancer Association
• Executive Committee Member of the Tumor Molecular Medicine Committee of the Chinese Anti-Cancer Association
• Chairperson of the Breast Disease Branch of the Guangdong Medical Association
• Deputy Editor-in-Chief of Chinese Journal of General Surgery and Chinese Journal of Endocrine Surgery
• PhD from National University of Singapore; Former Lecturer at Dana-Farber Cancer Institute, Harvard University
• Principal investigator of multiple major national projects, including several key programs of the National Natural Science Foundation of China and key international collaborations
• Pioneer in the application of liquid biopsy and combined immunotherapy in breast cancer
• Initiated and developed China’s first expert consensus on young breast cancer treatment
• Honored with the “Exemplary Physician of the Nation” title by People’s Daily in 2020
• Specializes in breast cancer diagnosis, surgery, and comprehensive treatment, with a focus on complex breast-conserving surgery, young breast cancer, and personalized precision therapy for triple-negative breast cancer