Editor’s Note: The “2023 Chinese Congress of Holistic Integrative Oncology (2023 CCHIO),” hosted by the China Anti-Cancer Association, and organized by Tianjin Medical University Cancer Institute & Hospital, Tianjin Anti-Cancer Association, and the China Research Institute of Development Strategies of Holistic Integrative Medicine, is scheduled to be held in Tianjin from November 16th to 19th, 2023. In the run-up to the conference, Oncology Frontier interviewed Professor Caicun Zhou from Shanghai Pulmonary Hospital of Tongji University, Chair of the Clinical Research Professional Committee of the China Anti-Cancer Association, to discuss the current trends and treatment of lung cancer in China and the achievements of Chinese lung cancer experts in leading and participating in international clinical research.
Oncology Frontier: Could you introduce the current trends and treatment status of lung cancer in China?
Prof. Cai-Cun Zhou: In recent years, the incidence of lung cancer in China has been on the rise, with a persistently high mortality rate, while in the United States, the incidence and mortality rates of lung cancer have been declining. The rising incidence of lung cancer in China is closely related to the large population of active and passive smokers, and the situation of cigarette control is unfavorable. In the diagnosis and treatment of lung cancer, early detection and treatment are crucial. Many regions have introduced low-dose spiral CT scans in health check-ups, which helps identify more early-stage lung cancer patients who can achieve clinical cure through surgery. For late-stage lung cancer patients, precision treatment based on molecular markers is emphasized, with gene-positive patients opting for targeted therapy and gene-negative patients choosing chemotherapy with immunotherapy. These systemic treatment approaches have led to certain improvements in the overall survival of lung cancer patients in China.
Thanks to the expansion of the medical insurance catalog and price negotiation, the accessibility of many new drugs in China has significantly increased, especially in the case of PD-1/L1 immunotherapy and targeted therapy, which are now affordable for the majority of the population. In the field of early treatment, ongoing investigations into neoadjuvant or adjuvant immunotherapy and targeted therapy provide promise for further enhancing the likelihood of cure for patients. In addition, we have conducted numerous translational research projects in the field of lung cancer, with some new diagnostic products and treatment strategies entering clinical practice, enabling doctors and patients to receive more precise treatment. Overall, lung cancer is an exemplar of precision cancer treatment, and Chinese lung cancer experts now have more opportunities to participate in and conduct clinical research.
Finally, I want to emphasize that lung cancer is a preventable and treatable disease, with the key being early detection and treatment. We need to shift the focus of prevention and treatment earlier to create more opportunities for cure in early-stage patients and allow late-stage patients to achieve long-term survival through precision treatment.
Oncology Frontier: “Cancer Control, Winning in Integration” is the cancer prevention and treatment concept advocated by the China Anti-Cancer Association. How do you think this concept of integrated medicine can be reflected in the practice of ovarian cancer diagnosis and treatment?
Prof. Cai-Cun Zhou: Lung cancer is a type of cancer where integrative medicine has been relatively well implemented. The screening, diagnosis, and treatment of early-stage lung cancer is a systematic approach. For example, recommendations for screening tools involve considerations of economic cost-effectiveness and require the involvement of experts from different fields to develop screening strategies. Over 90% of the lung nodules found in physical examinations are benign lesions, and their differential diagnosis requires input from multiple disciplines such as surgery, radiology, and pathology. Late-stage lung cancer is increasingly emphasizing individualized comprehensive treatment, which also requires the integration of various specialties, including surgery, internal medicine, respiratory medicine, radiation oncology, and radiology. Therefore, from the prevention and screening of lung cancer to the treatment of different stages, we need to integrate resources to provide the best lung cancer prevention and diagnostic and treatment strategies. Through these efforts, we can improve the effectiveness of resource utilization and establish more scientific standards and strategies for lung cancer prevention and treatment.
Oncology Frontier: Recently, two studies led by you (PAPILLON and LIBRETTO-431) were published in the New England Journal of Medicine (NEJM). Could you briefly introduce the results of these studies and how they demonstrate the crucial role played by Chinese researchers in international multicenter clinical trials?
Prof. Cai-Cun Zhou: In recent years, Chinese oncologists have made significant progress in clinical research, with numerous research findings presented on international academic stages such as ASCO and ESMO and published in major medical journals like Lancet, NEJM, JAMA, and BMJ. This demonstrates the rapid growth of the Chinese oncology field, and the research capabilities of Chinese clinical research teams are continuously improving. It can be predicted that soon, more Chinese experts will lead and participate in international multicenter studies, guiding Chinese-made innovative drugs to the global stage.
Clinical studies accepted for publication in NEJM often have a “game changer” clinical value. We know that EGFR exon 20 insertion is not a common mutation. It accounts for about 12% of EGFR-mutated NSCLC and 2% of all NSCLC cases, and it responds poorly to first, second, and third-generation TKIs. In the PAPILLON study, the dual-specificity EGFR and MET antibody, amivantamab, in combination with chemotherapy, significantly extended progression-free survival (11.4 vs. 6.7 months; HR 0.40; P < 0.001), with a trend toward overall survival benefit. This study provided a new standard first-line treatment option for such patients and was quickly accepted by NEJM. Another study, LIBRETTO-431, focused on first-line treatment for RET fusion-positive NSCLC. Pralsetinib has been approved for such lung cancer in China but is mainly used for second-line and later treatments. In the LIBRETTO-431 study, selpercatinib also significantly extended progression-free survival by more than twofold compared to platinum-based chemotherapy ± pembrolizumab (24.8 vs. 11.2 months; HR 0.46; P < 0.001), and, importantly, this small molecule TKI can penetrate the blood-brain barrier, providing better efficacy against intracranial lesions. This is the world’s first successful Phase 3 study of a RET inhibitor and will soon change the treatment strategy for such patients, thus being published in NEJM.
I want to extend my gratitude to my colleagues in China and abroad for their support, the pharmaceutical companies for their research initiatives, and all the staff involved in these clinical studies. The successful publication of these studies is the result of team efforts and not the achievement of a single person.
Oncology Frontier: As the Chair of the Clinical Research Professional Committee of the China Anti-Cancer Association, what are your expectations for the future development of clinical research on cancer drugs in China?
Prof. Cai-Cun Zhou: We hope to see more domestic pharmaceutical companies develop better treatment drugs. Under the leadership of our committee, we can conduct more nationwide and even global multicenter clinical studies, bringing these new treatment approaches to clinical practice and benefiting more patients through technological advancements. In the future, we should not be content with just domestic achievements; we hope that more Chinese-made solutions can go abroad and influence clinical practices in European and American countries. As lung cancer experts, our common goal is to conquer the disease, regardless of whether it benefits Chinese, Americans, or Europeans. We hope to challenge our common enemy, lung cancer, with the most effective weapons. This requires us to conduct better clinical research.
While conducting excellent clinical research is crucial, we also need to keep up with translational research. We need to innovate from the source, from target selection and drug development to preclinical and clinical research, as well as subsequent translational and real-world studies, to establish a complete biopharmaceutical industry chain and stand tall among the world’s nations. This is a vision cherished by clinical scientists like us.
