Editor’s Note: The 27th National Conference of Clinical Oncology and 2024 CSCO Academic Annual Meeting, jointly organized by the Chinese Society of Clinical Oncology and the Beijing Xisike Clinical Oncology Research Foundation, was successfully held in Xiamen from September 25 to 29, 2024. The conference included multiple sessions on lung cancer, which brought together the latest advances and frontiers in lung cancer research from both domestic and international perspectives. During the conference, Oncology Frontier invited Dr. Wenhua Liang from The First Affiliated Hospital of Guangzhou Medical University to share new clinical developments in immunotherapy combinations for non-small cell lung cancer (NSCLC) and recent breakthroughs in precision diagnostic pathways.

Oncology Frontier: As new drugs for lung cancer emerge, various combination therapies are being explored, improving patient outcomes. Could you discuss the latest progress in combining anti-angiogenic and immunotherapy in advanced NSCLC?

Dr. Wenhua Liang: In the CSCO Vascular Targeted Therapy Expert Committee session of the 2024 CSCO Academic Annual Meeting, a comprehensive review was conducted on the progress of immunotherapy combined with anti-angiogenic agents in first-line, second-line, and other non-chemotherapy treatments for advanced NSCLC. This combination has become a standard approach in many clinical practice scenarios and is a critical component of advanced NSCLC treatment.

For patients with unfavorable tumor microenvironments, such as those with EGFR and ALK gene mutations, immune escape mechanisms may promote a suppressive tumor immune environment. In such cases, anti-angiogenic agents are necessary to support the efficacy of immunotherapy. Real-world data also indicate that in patients with immune-suppressive environments, such as those with liver, bone, or pleural metastases, immunotherapy alone may not be effective without the aid of anti-angiogenic agents.

Moreover, in the maintenance phase, immunotherapy combined with anti-angiogenic agents may be beneficial. Our team introduced a novel “Chemo-holiday” regimen, which shows comparable tumor control times and possibly even superior OS in real-world data when combined with immunotherapy and anti-angiogenic agents post-chemotherapy.

Thus, the combination of immunotherapy and anti-angiogenic therapy builds upon existing treatments to enhance efficacy and provides a vital alternative for patients who cannot or choose not to undergo chemotherapy.

Oncology Frontier: In treating NSCLC patients, personalized treatment strategies are essential yet challenging. Could you share how you approach precision treatment for NSCLC patients?

Dr. Wenhua Liang: With recent updates in clinical guidelines, the treatment pathways are increasingly refined but still unable to fully meet the needs of every patient group. Therefore, I believe that precision treatment strategies for advanced NSCLC should include three key points:

1. Classification: Genetic profiling of tumors allows for a more direct assessment of a patient’s response to specific therapies, helping guide treatment decisions.
2. Stratification: This approach evaluates the disease severity through tumor staging, tumor aggressiveness, and drug resistance.
3. Dynamic Adjustment: During the treatment process, therapies should be adjusted based on the patient’s response.

In surgical settings, for example, if patients achieve complete remission (CR) with neoadjuvant therapy, subsequent maintenance therapy may not be necessary. For patients who do not reach CR, consolidation therapy can yield additional clinical benefits. The treatment process should be flexible, with monitoring indicators like ctDNA and MRD to evaluate the response and guide adjustments.

Oncology Frontier: As lung cancer research progresses, new drugs, technologies, and methodologies are continually applied in clinical practice. In your opinion, where is precision treatment for lung cancer likely to see breakthroughs?

Dr. Wenhua Liang: First, achieving clinical efficacy starts with accurate diagnostics. New molecular imaging techniques have great potential, providing accurate tumor localization and characterization. They can improve clinical decisions, especially in evaluating dynamic biomarkers such as PD-L1.

Our team has also developed the DeepGEM AI tool, which uses pathology slides to predict genetic mutations efficiently. This tool supports precision treatment even in economically challenged regions and enables faster decision-making for patients requiring immediate targeted therapy.

Additionally, AI-powered image analysis could offer a non-invasive way to analyze tumors’ molecular characteristics. This innovation has the potential to transform clinical decision-making, particularly for patients who cannot undergo biopsies.

In the drug development arena, while CAR-T, ADCs, and PROTACs show promise, I am optimistic about immunotherapy. The EGFR-targeted peptide mRNA vaccine our team is developing has shown promising results, with some patients achieving CR in early trials. This vaccine could also serve as a preventive measure for high-risk populations in the future, particularly given the high prevalence of EGFR mutations among Asian populations.

Dr. Wenhua Liang

Dr. Wenhua Liang, MD, PhD, is a professor, doctoral supervisor, and chief physician at The First Affiliated Hospital of Guangzhou Medical University. He serves as Director of the Comprehensive Thoracic Oncology Ward and Vice President of Hengqin Hospital. As a recipient of the National Science Fund for Excellent Young Scholars and an esteemed Young Pearl River Scholar, Prof. Liang has contributed significantly to the fields of lung cancer treatment and translational research.

Prof. Liang holds key leadership roles, including Assistant to the Dean of Guangzhou Institute of Respiratory Health, Deputy Director of the Lung Cancer Group at the State Key Laboratory of Respiratory Diseases, and Chief of the Immunotherapy Committee of the Guangdong Thoracic Disease Association. He is also a member of several prestigious societies, such as the CACA Lung Cancer Committee and the CSCO NSCLC Committee.

He has published over 280 SCI papers, with 28 articles exceeding an impact factor of 30, totaling over 2800 impact points, and has been cited more than 28,000 times with an H-index of 43. His work includes articles in top-tier journals such as Journal of Clinical Oncology, The New England Journal of Medicine, BMJ, The Lancet Oncology, and Cell Research. He has been recognized on the Stanford-Elsevier Lifetime List of the Top 2% of Global Scientists.

Prof. Liang has received numerous accolades, including the ASCO Merit Award, the “People’s Doctor” award by People’s Daily, and the inaugural Green Orange Award from Alibaba’s Damo Academy. He was also a core contributor to a team awarded the National Science and Technology Progress Award and the National Innovation Award.