Prof. Liu Qiang: China's breast cancer research is at the forefront of the world, and ctDNA guides the trend of precision treatment

BOC/BOA 2024丨Professor Liu Qiang: China's breast cancer research is at the forefront of the world, and ctDNA guides the development trend of precision therapy

Editor's note: On July 5-7, 2024, the 2024 China Annual Symposium on Clinical Oncology (BOC) and Beast of ASCO®2024 China (BOC/BOA) were held in Guangzhou. In the field of breast cancer, the conference captured key developments at the United States Society of Clinical Oncology (ASCO) Annual Meeting, highlighting the international impact of Chinese research. "Cancer Lookout" interviewed Professor Liu Qiang from Sun Yat-sen Memorial Hospital, Sun Yat-sen University, the host of the breast cancer session, to share the highlights and impact of the session, and point out the future development trend of breast cancer treatment.

01

Oncology Outlook: As one of the organizers of the BOC/BOA Breast Cancer Session, could you please share the important research and highlights of this session, and what are its important implications for clinical practice?

Prof. Qiang Liu: At the 2024 ASCO Annual Meeting, there will be an endless stream of blockbuster studies, many of which have the potential significance and value to change the way of treatment in the future. The BOC/BOA was held in Guangzhou, and our Chinese scholars discussed the above-mentioned research with great impact. It can be seen that in recent years, China's research has advanced by leaps and bounds, and Chinese scholars and enterprises have worked together to launch many blockbuster research results, such as in the field of cutting-edge antibody drug conjugates (ADCs), ADC drugs with independent innovation for HER2 targets and TROP-2 targets have been launched, and corresponding blockbuster phase III clinical research results have been released, which have achieved very good results, thus reflecting the level of Chinese scholars to keep up with and even lead the world's frontier. Chinese enterprises are also constantly strengthening cooperation with scholars, and have made a lot of achievements one after another, so as to go abroad and go to the world.

02

Oncology Lookout: What do you think is the current state of international cooperation and exchanges in the field of breast cancer, and what are the successful cooperation cases that can be shared?

Professor Liu Qiang: More than ten years ago, compared with China, the scientific research level in the field of breast cancer in Europe and United States was very high, and it was in a leading position in the world. At that time, Chinese clinicians were more likely to play the role of students, learning from foreign clinical studies and formulating diagnosis and treatment strategies for breast cancer patients with reference to foreign guidelines. However, in the past 5-10 years, the research level and research results of Chinese scholars have shown a trend of rapid progress. At the same time, the international status of the mainland in the field of breast cancer is also rising, and scholars have more voice in the world. For example, the St. Gallen International Breast Cancer Conference has now included four Chinese experts, who will discuss hot issues in the diagnosis and treatment of early breast cancer in the biennial meeting, and vote on the focus and difficult issues of lack of evidence-based medical evidence, so as to form a new international expert consensus on breast cancer. I was also honored to be a member of the ESO-ESMO International Consensus Expert Group on Young Breast Cancer and participated in the development of the International Consensus on Young Breast Cancer. In addition, many Chinese experts are actively participating in international exchanges and cooperation, and have made some achievements.

With the publication of more and more data from large-scale randomized controlled clinical studies, more and more drugs have been developed, and the level of scientific research in the field of breast cancer in China is also gradually improving. Today, China has achieved parallel performance with countries such as Europe and the United States, and has even reached the level of local leadership. We have seen that many drugs developed by Chinese companies are gradually being promoted to the world to benefit more breast cancer patients around the world, and it can be said that the role of Chinese scholars in this is not negligible. In the future, we will strengthen international cooperation and carry out more international large-scale clinical studies, so as to benefit more breast cancer patients around the world.

03

Oncology Lookout: What is the current international impact of breast cancer research in China? What are some of the most important studies at ASCO that stand out to you and deserve further exploration and reference?

Prof. Liu Qiang: In recent years, in addition to the progress in the field of ADC mentioned earlier, many achievements have been made in the field of breast cancer in China, such as the development of new targets, the development of new drugs, and the field of precision therapy related to circulating tumor DNA (ctDNA), which has promoted the improvement of the international diagnosis and treatment level of breast cancer.

At this ASCO meeting, there were a number of sessions dedicated to ctDNA-related advances. The MonarchE study analyzed the ctDNA of 910 patients to explore how to further accurately screen early-stage, high-risk patients. The results of this study, which is currently the largest ctDNA-related study in HR+/HER2- breast cancer, showed that 87 percent of ctDNA-positive patients had IDFS events, suggesting that ctDNA testing is an effective method to identify and enrich high-risk patients [1].

At this BOC/BOA meeting, we also had an in-depth discussion on the study. Nowadays, the cure rate of early-stage breast cancer can reach 70~80%, and more benefits will be brought to patients by more fine stratification, accurate identification of high-risk patients, and intensive treatment. At present, all subtypes of breast cancer have made great progress in intensive adjuvant therapy, and how to further accurately screen patients in need of intensive therapy is one of the important tasks in the future, and ctDNA has shown a very good application prospect in this regard.

04

Oncology Lookout: Please tell us about the research directions that your team is currently working on, and what is the progress and results of this research?

Professor Liu Qiang: Individualized precision treatment of breast cancer has become one of the current development trends. In April this year, an article in JAMA reported that some early-stage triple-negative breast cancers could be exempted from chemotherapy. The study included 1,966 patients with stage I.-II early-stage triple-negative breast cancer and had a 5-year survival rate of more than 70% without distant recurrence in the absence of chemotherapy. The study noted that the higher the abundance of tumor-infiltrating lymphocytes (TILs), the more likely patients were to be exempt from chemotherapy[2].

The research of our team has also shown that not all breast cancer patients need strong systemic treatment. The reason for this is that some breast cancers occur mainly locally or in local lymph nodes, and do not necessarily enter the bloodstream to cause distant metastasis. In the past, it was not possible to analyze whether cancer cells had entered the bloodstream, but now it can be verified by tumor-specific ctDNA in the blood. At present, we have an article in the paper, in which 21.7% of patients were ctDNA-negative, the prognosis was very good, and none of the patients had recurrent metastases. Some of these patients have a good prognosis with a clinical stage of stage III and more lymph node metastases. These results suggest that ctDNA can assist in predicting the prognosis of triple-negative breast cancer patients.

Nowadays, we have entered the era of precision treatment, and ctDNA testing in blood is bound to help us distinguish the risk level of patients more finely, so as to select individualized intensive treatment or down-step treatment in a targeted manner, which will be an inevitable trend in the development of breast cancer.

▌References:

1.Sherene Loi, Prognostic utility of ctDNA detection in the monarchE trial of adjuvant abemaciclib plus endocrine therapy (ET) in HR+, HER2-, node-positive, high-risk early breast cancer (EBC). 2024 ASCO abstract LBA507.

2.Leon-Ferre RA, Jonas SF, Salgado R, et al. Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer. JAMA. 2024; 331(13):1135-1144. doi:10.1001/jama.2024.3056

Prof. Qiang Liu

Professor, Chief Physician, Researcher, Doctoral Supervisor

Director of the Department of Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Executive Vice President of Yat-sen Breast Cancer Hospital, Director of the Breast Cancer Center, and Director of the Department of Breast Surgery

Member of the ESO-ESMO International Consensus Expert Group on Young Breast Cancer

He is a standing member and deputy secretary-general of the Breast Cancer Committee of the Chinese Society of Clinical Oncology

He is a member of the Standing Committee of the Breast Cancer Committee of the Chinese Anti-Cancer Association

He is a member of the Standing Committee of the Tumor Molecular Medicine Committee of the Chinese Anti-Cancer Association

Chairman of the Breast Disease Branch of Guangdong Medical Association

Associate Editor-in-Chief of the Chinese Journal of General Surgery and Deputy Editor-in-Chief of the Chinese Journal of Endocrine Surgery

Doctor of Surgery from the National University of Singapore, and lecturer at Dana Farber Cancer Center at Harvard University before returning to China

He has presided over a number of major national projects, including a number of national natural key projects and key projects of international cooperation, took the lead in the application of liquid biopsy and immunotherapy in breast cancer, and initiated and formulated China's first expert consensus on the diagnosis and treatment of young breast cancer, and was awarded the honorary title of "Excellent ·Style of Famous Doctors of the Country" sponsored by People's Daily in 2020. He specializes in the diagnosis, surgery and comprehensive treatment of breast cancer, especially the difficult breast-conserving surgery, individualized precision treatment of young breast cancer and triple-negative breast cancer.