New Therapy Improves Intermediate Liver Cancer Cure Rate by 55 Percent

Liver cancer is the sixth most common cancer in the world, with more than 900,000 new cases every year, and a fatality rate that ranks third among all cancers. Recently, the Li Ka Shing faculty of medicine of the University of Hong Kong (HKU) released the world’s first comprehensive treatment plan for intermediate liver cancer, called the “Reduce and Remove” program. Clinical studies have shown that for intermediate liver cancer that cannot be removed by surgery, nearly 50 percent of patients can achieve a radical curing effect through the comprehensive treatment plan of “Reduce and Remove.” The research results have been published in the Dec. 2022 edition of The Lancet Gastroenterology and Hepatology. Liver cancer is one of the top 10 cancers in the world. According to the Hong Kong Cancer Database, there are nearly 1,800 new cases of liver cancer in Hong Kong every year, of which only 30 percent are suitable for curative surgery to achieve complete rehabilitation, while the remaining 70 percent can only receive non-curative treatment to control the disease due to conditions such as enlarged tumor size or vascular invasion. To improve the chances of liver cancer cure and the survival rate of patients, the team of the HKU Faculty of Medicine recruited 33 liver cancer patients from March 2019 to January 2021. The diameter of the tumors ranged from 5 to 17.5 cm (about 2 to 7 in), and 64 percent of the patients had tumors that had invaded the large blood vessels that could not be cured immediately by surgery. The 33 patients were treated with the new “Reduce and Remove” tri-modality therapy (START-FIT). The patient received transarterial chemoembolisation on the first day of treatment to control the tumor, and stereotactic body radiotherapy on day 28 to attack the tumor head-on. The PD-L1 immunotherapy Avelumab treatment was given 14 days later—then once every 2 weeks to continue striking the cancer cells and shrink the tumor to a size appropriate for surgical removal, thereby eradicating the cancer. Eighteen patients (about 55 percent) were considered suitable for surgery after receiving the tri-modality therapy, among which four patients (about 12 percent) underwent curative surgery, and 14 (42 percent) were selected for regular close monitoring by imaging as the tumor cells were completely necrotic. The subsequent two-and-a-half-year follow-up showed a survival rate of more than 90 percent within two years. The study reported the treatment’s approach is “minimally invasive with short hospital stay and a relatively high safety profile,” with the most common side effects including “temporary liver function derangement after TACE,” with some patients developing a “mild immune reaction.” The “Reduce and Remove” therapy provides an opportunity for liver cancer patients who are not suitable for surgery to be otherwise successfully treated. The full-term treatment costs are around HK$200,000—about U.S.$25,600. Chan Chi-yan, a clinical professor of the Department of Surgery, School of Clinical Medicine, said: “This treatment strategy provides a definite treatment schedule. Most patients could have an idea of the treatment effect within 6 months after the start of treatment and be able to have better planning for themselves and their families.” Chan added, “Now the team is looking forward to expanding the treatment coverage to more patients, especially those with poor liver function, to help downstaging the tumor status and hence, increase the chance of fitting into the criteria for liver transplantation in the future. We are also seeking ways to improve the efficacy of immunotherapy, from a single agent to double agents, to deliver a more enhanced and solid treatment result.”