Editor’s Note: The 9th Academic Symposium of the Chinese Branch of the International Hepato-Pancreato-Biliary Association (IHPBA) was held in Wuhan from October 25-27, 2024, drawing renowned experts from over 20 countries, including the United States, Germany, France, Russia, and Australia. With more than 50 prominent international scholars, 21 academicians, and over 700 experts in liver, gallbladder, and pancreas oncology, the symposium provided a platform to discuss the latest advancements and standards in liver cancer diagnosis and treatment. Dr. Tianqiang Song from Tianjin Medical University Cancer Institute and Hospital delivered an insightful presentation on “Advancements in Perioperative Treatments for Liver Cancer and the Tianjin Experience.” In a joint interview with Oncology Frontier, Professor Song shared insights into perioperative treatment research and practical experiences.

Oncology Frontier: In this symposium, you presented on “Advancements in Perioperative Treatments for Liver Cancer and the Tianjin Experience.” Could you summarize the key points for our readers?

Dr. Tianqiang Song: In this conference, I highlighted recent advances in perioperative treatments for liver cancer. Currently, surgical resection is still the primary curative treatment for liver cancer, but high recurrence rates post-surgery remain a significant barrier to long-term efficacy.

The field of adjuvant treatments has seen extensive exploration, from interventional therapy and sorafenib-based targeted therapy to the latest immune-targeted combination therapies. Despite these efforts, many large randomized controlled trials (RCTs) have not yielded positive outcomes, falling short of desired efficacy. However, ongoing research continues, and we eagerly anticipate upcoming reports.

Neoadjuvant therapy is another essential component of perioperative treatments, aiming to shift treatment earlier to reduce tumor size or lower recurrence risks post-surgery. This area is relatively new, but the advent of combination therapies, especially immunotherapies, offers more viable options. At our center, we have been conducting studies on patient selection and developing neoadjuvant regimens.

Today, I shared some preliminary findings from our center, suggesting that personalized treatment approaches may be the most practical route forward. A single treatment strategy cannot address the needs of every patient population, so personalized treatment is likely to be a major direction for future development.

Oncology Frontier: With the IMbrave050 trial failing to meet its primary endpoint for recurrence-free survival (RFS), perioperative treatments for liver cancer seem to be back at square one. What are some ongoing pivotal trials that could bring breakthroughs in this field?

Dr. Tianqiang Song: Although the IMbrave050 trial’s RFS result was negative, it does not imply that the approach or strategy is inherently flawed. The main issue may lie in patient selection, as the trial included some patients who were not at extremely high risk of recurrence, which could have diluted the true efficacy of the treatment.

For adjuvant therapies involving targeted and immune agents, we should focus on patients with very high recurrence risks. Biomarker-based selection, such as pre-surgical levels of alpha-fetoprotein (AFP >1000 ng/mL), multiple tumors, or vascular involvement, could help identify these high-risk individuals. By integrating biomarker data, especially from minimal residual disease (MRD) tests, we can more accurately target at-risk populations and administer targeted or immune treatments to achieve better outcomes.

Currently, several clinical studies are exploring various adjuvant strategies, including the double-A combination of toripalimab and apatinib, and combinations of local and systemic therapies. These studies’ results are highly anticipated, as a single negative result does not negate the potential of adjuvant therapy. Rather, I believe we are in a “spiral progression” phase where each perceived setback actually prepares us for a stronger upward push.

Oncology Frontier: How do you view the role of TACE and HAIC in perioperative settings? What are the pros and cons of using these methods pre- and post-surgery?

Dr. Tianqiang Song: TACE (transarterial chemoembolization) and HAIC (hepatic arterial infusion chemotherapy) are two valuable interventional options, each with distinct advantages and limitations. TACE is primarily used to block the blood supply to the tumor, causing ischemia and hypoxia, which inhibits tumor growth and induces cell death. However, TACE in the perioperative setting may complicate the surgery with adhesions or postoperative complications like fever and pain.

In contrast, HAIC is better suited for cases with large tumors, portal vein thrombosis, or extensive disease that requires tumor downsizing to facilitate surgical resection. Unlike TACE, HAIC is less likely to cause adhesions in the surgical area, making it a preferable option for neoadjuvant treatments. HAIC may also be more effective post-surgery as an adjuvant treatment because it can deliver targeted chemotherapy to subclinical lesions that imaging may not detect.

For perioperative settings, HAIC may be more reasonable than TACE, especially for resectable cases. However, for advanced or unresectable cases requiring conversion therapy, combining HAIC and TACE might be more appropriate.

Oncology Frontier: In exploring future perioperative treatment strategies for liver cancer, what new approaches or strategies show the most promise? What lessons from previous research could guide future developments?

Dr. Tianqiang Song: The main perioperative treatment strategies for liver cancer currently include local, systemic, and combined local-systemic treatments. Identifying suitable patient groups for each strategy is critical. For instance, some patients may benefit solely from immunotherapy, while others may require a combination with targeted therapies. For patients who do not respond to targeted or immune therapies, local treatments might be a better option.

Different tumor types also respond differently to these therapies. For example, certain tumors respond well to TACE, while others are more effectively treated with HAIC. Therefore, future research should focus on patient stratification and applying specific, tailored treatments based on these stratifications. We should not expect a single approach or strategy to work for all patients.

Dr. Tianqiang Song Executive Director, Liver Cancer Prevention and Treatment Research Center Department Head, Liver and Gallbladder Oncology, Tianjin Medical University Cancer Institute and Hospital Member, IHPBA Research Committee Executive Member, Chinese Society of Clinical Oncology Deputy Chairman, Liver Tumor Committee, China International Exchange and Promotion Association for Medical and Health Care