Editor’s Note: From November 14 to 17, 2024, the highly anticipated 2024 Chinese Congress on Holistic Integrative Oncology (CCHIO) was held in Xi’an. The event, hosted by the China Anti-Cancer Association and co-organized by the Shaanxi Anti-Cancer Association and the Institute for Development Strategy of Holistic Integrative Medicine , gathered leading experts in oncology.At the conference, Oncology Frontier had the privilege of interviewing Dr. Lin Shen from Peking University Cancer Hospital. The discussion focused on current hotspots and future directions in digestive cancer research during the era of precision medicine.

Oncology Frontier: As cancer treatment advances into the precision medicine era, what are the key elements required to achieve precision oncology?

Dr. Lin Shen: This is a topic that garners significant attention, as patients often ask us whether their treatment will be effective. Physicians typically respond by discussing probabilities, which reflect the extent to which precision treatment has been realized. Precision treatment ideally aims for a 100% success rate, but we are not there yet. For some patients, the success rate may be as high as 60–70%, while for others, it may be as low as 30–40% or less. Improving these success rates remains a shared goal for researchers and clinicians.

Why is it challenging to achieve optimal outcomes in precision cancer treatment? The answer lies in the complexity of cancer, particularly solid tumors. The tumor microenvironment is highly intricate, and external factors significantly influence its dynamics. This complexity was a major focus at the conference, as participants explored tumor microenvironments, carcinogenesis, and etiological factors. However, since tumors are constantly evolving, our real-time understanding of their mechanisms remains incomplete. Current targeted and immunotherapy approaches address specific targets or the tumor growth environment but cannot guarantee effectiveness for all patients. Relapses also remain a significant challenge, the causes of which are not yet fully understood. Addressing these issues is at the forefront of ongoing research.

Despite these challenges, I am optimistic about the future of precision therapy. Achieving this goal requires integrating new treatment modalities, such as innovative drugs, radiotherapy, surgery, and localized therapies, while minimizing adverse effects. Following the multidisciplinary approach advocated by the China Anti-Cancer Association, we must focus on individualized treatment plans tailored to each patient. This is not only the direction of our research but also the expectation of our patients. With sustained effort and time, I believe precision cancer therapy will continually advance.

Oncology Frontier: Could you share your strategic plans and insights into precision therapy for digestive cancers to provide a reference for your peers?

Dr. Lin Shen: My research primarily focuses on upper gastrointestinal cancers, including gastric and esophageal cancers. These cancers are highly prevalent in China, with esophageal cancer accounting for over 53% of global cases and gastric cancer for more than 47%. Developing precise treatment strategies for these cancers has always been our goal.

Initially, treatment options were limited to chemotherapy drugs like fluoropyrimidines, platinum compounds, taxanes, and topoisomerase inhibitors. However, today we have a broader range of options, including targeted therapies for EGFR, HER2, and emerging targets like Claudin and FGFR. In exploring these approaches, we have gained a deeper understanding of the complexity and heterogeneity of digestive system cancers. Admittedly, our progress in this area lags behind that of non-small cell lung cancer or breast cancer due to less global investment in research. However, with increased support from the Chinese government and rapid advancements in the pharmaceutical industry, access to new drugs has improved significantly.

Chinese scientists have also made significant contributions to gastrointestinal cancer research. Leveraging foundational research and new drug developments, we have conducted numerous clinical studies targeting various markers, including MET and HER3. These efforts have not only advanced treatment but also uncovered new challenges, such as drug resistance.

To address these issues, we are exploring novel therapeutic approaches, including drug combinations, cell therapies, and gene therapies. China is already leading in cell therapy for gastrointestinal cancers, driven by patients’ urgent need for improved outcomes.

Through these efforts, we have identified innovative therapies that offer long-term benefits and, in some cases, the possibility of curing the disease with just one treatment. This is the essence of precision therapy: a continuous cycle of clinical trials, translational research, and clinical validation that drives progress. I firmly believe that we will meet the needs of Chinese patients with gastric and esophageal cancers and eventually benefit patients worldwide. Chinese doctors and scientists are poised to lead the global effort in this field.

Oncology Frontier: If we consider 100% as the full realization of precision medicine, where do you think we currently stand?

Dr. Lin Shen: While we still have a long way to go before fully realizing precision medicine, I believe we have achieved approximately 30% of the journey. We have already witnessed transformative advances, such as the use of immunotherapy drugs, particularly anti-PD-1 monoclonal antibodies. These therapies have enabled patients with high microsatellite instability (MSI-H) tumors to achieve cures without surgery.

Combining anti-HER2 treatments with targeted immunotherapy has also provided long-term survival benefits. In perioperative settings, this approach has tripled pathologic complete response rates, effectively doubling the likelihood of a cure. Immunotherapy is showing similar promise in perioperative treatment for esophageal and gastric cancers. Currently, phase III randomized controlled trials are underway to evaluate whether these treatments can improve five-year survival and cure rates.

Only by progressively advancing therapies from late-stage to curative platforms can we address the core challenges in this field: increasing five-year survival and cure rates. These goals remain central to our ongoing efforts.

Dr. Lin Shen

• Current Roles: Director of the Department of Digestive Oncology, Peking University Cancer Hospital Director of Phase I Clinical Trial Ward, Peking University Cancer Hospital
• Previous Roles: Vice President, Peking University Cancer Hospital Deputy Director, Beijing Institute for Cancer Research
• Accolades: Beijing Scholar Chair, Precision Oncology Professional Committee, China Anti-Cancer Association Founding Chair, Clinical Oncology Drug Research Professional Committee, China Anti-Cancer Association Chair, Clinical Research Expert Committee, Chinese Society of Clinical Oncology (CSCO) Incoming Chair, Gastric Cancer Expert Committee, CSCO Vice Chair, Colorectal Cancer Committee, China Anti-Cancer Association Chair, Clinical Oncology Committee, Chinese Women Doctors Association