Editor’s Note: From September 25 to 29, 2024, the 27th National Conference on Clinical Oncology and the 2024 CSCO Annual Meeting, co-hosted by the Chinese Society of Clinical Oncology (CSCO) and the Beijing Xisike Clinical Oncology Research Foundation, was held in Xiamen. Themed "Patient-Centered, Shared Future," the conference attracted tens of thousands of oncology experts and pharmaceutical elites from home and abroad to discuss the latest advancements in cancer prevention and treatment, cutting-edge technologies, and future trends. During the conference, Oncology Frontier had the honor of interviewing Dr. Shukui Qin, one of the founders and Vice President of CSCO. In this interview, Professor Qin reflected on CSCO’s remarkable journey since its founding in 1997, including its development through three major phases: preparation, institutionalization, and cultural growth. Supported by the Party and the government, CSCO has actively promoted five core tasks: continuing medical education in clinical oncology, academic exchanges, clinical research, expert consensus formulation, and patient services, achieving remarkable progress. Professor Qin highlighted the extraordinary progress in primary liver cancer treatment, from stagnation to breakthroughs, emphasizing CSCO’s ongoing efforts to foster multidisciplinary collaboration, strengthen basic and translational research, and explore "combination strategies" to significantly improve the survival rates of liver cancer patients.

CSCO Conference Review and Outlook

27 Years of Development and Contribution

Dr. Shukui Qin: This year’s CSCO conference in Xiamen was grand, with a large number of participants and a strong academic atmosphere. Since CSCO was founded at the Beijing Hotel in April 1997, it has undergone 27 years of development. I have had the privilege of witnessing CSCO’s growth and progress, having served as Secretary-General, Chairman, Vice President, and President of the CSCO Foundation.

CSCO’s development can be divided into three phases: the preparation phase, the institutionalization phase, and the cultural construction phase. Over the years, we have received tremendous support from the Party and the government and have undertaken five key tasks: continuing medical education in clinical oncology, promoting domestic and international academic exchanges, facilitating collaborative clinical research, formulating expert consensus and practice guidelines, and patient education, including humanistic care and science communication.

In terms of continuing education, we are committed to improving cancer diagnosis and treatment levels at grassroots hospitals and county-level doctors. In terms of academic exchange, we have established strong relationships with international oncology organizations such as ASCO, ESMO, and JSCO, significantly promoting academic exchanges both domestically and internationally. We have also facilitated various collaborative clinical studies, making clinical oncology research one of the most active areas. Additionally, we have developed a series of expert consensus and clinical practice guidelines to standardize clinical practice and improve the quality of diagnosis, treatment, and research.

Furthermore, we prioritize patient services, education, humanistic care, and science communication. These efforts span across all five of our core tasks, and we have continuously strived to uphold them. I would like to express my gratitude to the Party and the government, as well as the collective efforts of both senior and contemporary experts. Currently, CSCO boasts 44,700 individual members, with over 70% holding senior or intermediate titles, injecting vitality into the fight against cancer.

Personally, I have benefited greatly from my involvement with CSCO, improving my clinical, research, academic, and management skills. This is due to the support of the hospital leadership, the efforts of oncology colleagues in the military, and CSCO’s continuous backing. Finally, I extend my heartfelt thanks to the National Health Commission, the National Medical Products Administration (NMPA), the National Healthcare Security Administration, the Ministry of Science and Technology, the Ministry of Civil Affairs, and other relevant departments for their guidance and care. I also thank all our members for their collective efforts and the support of society and the media. We will continue to work hard to conquer cancer and contribute to the health of the people. Looking ahead, we firmly believe that under the leadership of the Party and the government, CSCO will thrive and contribute significantly to the development of clinical oncology in China and around the world.

Progress and Challenges in Liver Cancer Treatment

Strengthening Translational Research and Exploring “Combination Strategies” in Liver Cancer

Dr. Shukui Qin: In recent years, we’ve made remarkable progress in cancer treatment. Surgery remains the preferred treatment option, supported by radiotherapy, chemotherapy, and emerging targeted and immunotherapy approaches, all of which continue to advance rapidly. These achievements are closely tied to the integration of basic, translational, and clinical research. However, liver cancer, a long-standing malignant tumor with a high incidence in China, despite notable advances in treatment over the past decade, still presents a significant challenge. Since 2007, China has approved up to 15 first- and second-line drugs and treatment regimens for advanced liver cancer, but the survival benefits remain far behind those of lung cancer and breast cancer. For instance, the overall 5-year survival rate for breast cancer in China has surpassed 90%, while for liver cancer, it remains only around 12%–14%. Although liver cancer is no longer called the “king of cancers,” its highly malignant, invasive, and specific nature requires ongoing efforts to overcome these challenges.

Unfortunately, no definitive driver gene or mature molecular subtype for liver cancer has been identified despite extensive research. In contrast, lung cancer has already seen the development of targeted therapies for a range of oncogenic mutations. As a result, liver cancer treatment still heavily relies on traditional methods, which we might humorously call “benchmark treatments.” To make breakthroughs, we must strengthen collaborations with experts in basic and translational research, aiming to achieve significant discoveries in the mechanisms of liver cancer, identify driver genes or key genes, and guide clinical treatment.

At this stage, we cannot sit idle. Instead, we should plan and rationally combine existing treatment strategies and drugs to form a powerful “combination strategy.” Currently, advanced liver cancer treatment focuses on three areas: vascular-targeted therapies (such as donafenib and apatinib), immunotherapy (such as PD-1/PD-L1 checkpoint inhibitors), and systemic chemotherapy, including oxaliplatin-based regimens. We should explore how to integrate these strategies and drugs to enhance treatment efficacy.

Of course, safety is a key consideration in this process, and clinical studies must rigorously validate these combinations. Supported by the NMPA and especially the Center for Drug Evaluation (CDE), we conducted the DUBHE-H-308 study. This randomized, open-label, adaptive Phase II/III trial aims to evaluate the efficacy and safety of QL1706 (a novel PD-1 and CTLA-4 combination antibody) in combination with bevacizumab and/or XELOX chemotherapy as first-line treatment for advanced hepatocellular carcinoma. The Phase II results showed significant efficacy and safety with QL1706 combined with bevacizumab and the triplet regimen. This study is a result of teamwork in clinical research and strong collaboration with domestic pharmaceutical companies. The CDE has highly recognized the design and results of the Phase II trial and recommended further development in a Phase III trial. We will continue working diligently to complete this study and hope to provide an effective and safe treatment option for liver cancer patients in China.

The Future and Outlook of Liver Cancer Treatment

From Stagnation to Breakthroughs, Multidisciplinary Collaboration Paves the Way

Dr. Shukui Qin: If we take 2007 as a turning point, before this, liver cancer treatment faced a lack of effective drugs, primarily relying on symptomatic supportive care—a regrettable chapter in treatment history. The advent of sorafenib in 2007 marked the beginning of the era of molecular targeted therapies. Although sorafenib’s objective efficacy was limited, and its survival benefit was modest, with significant adverse reactions, it paved the way for future targeted therapies.

However, from 2007 to 2017, targeted therapy for liver cancer entered a period of stagnation. The uniqueness of liver cancer lies in the fact that the same patient, at the same time and in the same organ, may have underlying liver disease (including hepatitis, cirrhosis, liver dysfunction, and related complications) along with highly malignant cancer. These factors interact and create a vicious cycle. Therefore, diagnosis, treatment, and research must address both aspects simultaneously. At that time, due to insufficient understanding of liver cancer’s complexity, many studies ended in failure.

Fortunately, with the emergence of new-generation targeted drugs like lenvatinib, donafenib, and apatinib, 2017 brought better outcomes for liver cancer, particularly with the advent of PD-1/PD-L1 checkpoint inhibitors, which offered new hope for liver cancer patients. In recent years, we’ve entered an era of combination immunotherapy, with combination studies of immunotherapy and chemotherapy, immunotherapy and targeted therapy, and dual immunotherapy emerging, such as the HIMALAYA study, CARES-310, and CM-9DW studies. These developments have enriched the treatment options for liver cancer.

Currently, a series of clinical studies on liver cancer treatment are actively underway in China. Notably, a group of leading experts, including Academicians He Fuchu and Fan Jia, are dedicated to multigene research on the mechanisms of liver cancer, particularly in the field of proteomics, which has provided us with new insights. Research indicates that the development of liver cancer is closely related to metabolic disorders in the body, especially lipid metabolism. Therefore, lipid-lowering drugs may play an important role in treating liver cancer, and we are actively exploring this field with the hope of conducting related clinical studies. In addition to leveraging current strategies and drugs, we are planning comprehensive combination therapies. This includes not only drug selection but also full-course management and multi-faceted intervention, from advanced treatment to adjuvant and neoadjuvant therapy.

Looking ahead, liver cancer treatment is poised for breakthroughs. However, while the future is bright, the road ahead is challenging, requiring persistent effort. To achieve this, we must strengthen multidisciplinary collaboration. On one hand, we need to build close partnerships with experts in basic and translational research. On the other hand, specialists in oncology, surgery, radiology, interventional medicine, and hepatology must work together to contribute to the diagnosis and treatment of liver cancer. We firmly believe that, with the attention and support of the Party and the government, and through the tireless efforts and unity of our colleagues, we will achieve even greater and more remarkable progress in liver cancer diagnosis and treatment in the future.

Dr. Shukui Qin

Academic Advisor, Chief Physician at the First Affiliated Hospital of China Pharmaceutical University (Nanjing Tianyinshan Hospital) Editor-in-Chief of Journal of Clinical Oncology Professor and Doctoral Supervisor at China Pharmaceutical University, Nanjing Medical University, and Nanjing University of Chinese Medicine Expert in the Central Health Care Committee Executive Director of the Federation of Asian Clinical Oncology (FACO), Society for Immunotherapy of Cancer (SITC), and Asian Clinical Oncology Society (ACOS) Vice President of CSCO Chairman of the Supervisory Board of the Beijing CSCO Foundation Core Expert in Hematology and Oncology for the NMPA Advisory Committee Chairman of the Expert Committee on Oncology Capacity Building and Continuing Education for the National Health Commission President-elect of the Jiangsu Anti-Cancer Association