*For medical professionals only
Adhere to the people-oriented, pay attention to the whole process management
Finishing | Medical Coverage Group
In September, the 27th National Congress of Clinical Oncology and the 2024 Chinese Society of Clinical Oncology (CSCO) Annual Meeting were held at the Xiamen International Conference Center from 25th to 29th. As one of the most influential and highest-level academic events in the field of oncology in China, this year's CSCO Annual Meeting will bring together top oncology experts, scholars and industry elites at home and abroad to discuss the latest progress, cutting-edge technologies and future trends in cancer prevention and treatment.
In order to fully discuss and interpret the latest progress and trends in the academic content and field during this conference, the "medical community" specially invited Professor Li Zhiming from the Cancer Prevention and Treatment Center of Sun Yat-sen University to be a guest on the "Famous Doctor Kung Fu Tea" column to share the wonderful content and personal academic views of the conference.
Q1
In recent years, with the rapid development of clinical research in China, China is playing an increasingly important role in the field of diffuse large B-cell lymphoma (DLBCL). What impact has it had on the treatment of patients in mainland China?
Professor Li Zhiming: In recent years, with the development and progress of the economy, science and technology and social living standards in the mainland, the importance of anti-lymphoma drug research and development has been increasing, and the mainland has also made great progress in the independent research and development of new anti-lymphoma drugs, with 6-8 new drugs approved for marketing almost every year, and more Chinese scholars have participated in global or national multi-center clinical studies as major researchers, and significant progress has been made in the research and development of drugs from biosimilar antibodies to antibody drug conjugates (ADCs), bispecific antibodies, and polyclonal antibodies, and the gap with the international community has been significantly shortened. A number of clinical studies led by Chinese scholars have contributed more and more "Chinese wisdom" to the development of international oncology, realizing the transformation from following to running, and may even lead in the future.
The GUIDANCE-01 phase II randomized study conducted by the team of Professor Zhao Weilin from Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine evaluated the efficacy and safety of "R-CHOP-X" regimen in patients with DLBCL of different molecular subtypes. The Phase III clinical trial is actively underway, and we look forward to the publication of more study data to further optimize the clinical strategy. Another DEB study using chidamide combined with R-CHOP in the treatment of MYC/BCL2 dual-expression naïve DLBCL was selected for the 2024 United States Society of Clinical Oncology (ASCO) Annual Meeting LBA, which proved that chidamide combined with R-CHOP can be an effective first-line treatment option for this subgroup. The phase III randomized, double-blind, parallel-controlled, multicenter clinical study of zebetuzumab combined with CHOP in adult patients with DLBCL conducted by my team was also selected for the 2024 European Society of Hematology (EHA) Annual Meeting, and the results showed that zebetuzumab showed stronger anti-tumor potential and higher complete response (CR) rate than rituximab, and showed good tolerability, with a lower incidence of treatment-related grade 3 and above adverse drug reactions (such as infectious pneumonia).
In short, at present, young and middle-aged hematological oncology scholars in China are rising rapidly and gradually becoming the main force of the academic frontier, and in the future international academic conferences, we will see more breakthrough research progress from China, and clinical evidence from the Chinese population will also provide more targeted and standard treatment for domestic patients, improve the treatment level of Chinese DLBCL patients, and maximize the clinical prognosis of patients.
Q2
30% to 40% of patients still relapse or progress after first-line treatment with DLBCL, and the prognosis of patients with relapsed/refractory (R/R) DLBCL is poor. Can you tell us about the current status of R/R DLBCL? What are the unmet treatment needs?
Prof. Zhiming Li: After first-line standard treatment with R-CHOP, about 40% of patients with DLBCL will still have recurrence or refractory. Due to the high heterogeneity of DLBCL, the prognosis of patients varies greatly, such as high lymphoma International Prognostic Index (IPI) score, old age, non-GCB phenotype, double-blow lymphoma, double-expression lymphoma and other high-risk patient subtypes are often incurable by first-line treatment. Patients with early recurrence who did not reach 24-month progression-free survival (PFS24) had worse outcomes, with a median overall survival (OS) of 7.2 months and a 5-year OS rate of only 19% after disease progression. The 5-year OS rate for patients who achieved PFS24 was 87.6%.
At present, high-dose salvage chemotherapy sequential autologous stem cell transplantation (HD-ASCT) is still the standard treatment option for R/R DLBCL, but only half of R/R DLBCL patients are suitable for ASCT. About 50% of patients who are candidates for ASCT are unable to undergo ASCT because rescue chemotherapy does not achieve remission. Ultimately, only about 10% of patients with R/R DLBCL have a long-term cure with HD-ASCT, and the remaining 50% of patients who are not transplant candidates lack accepted standard treatment options and have limited treatment options, including second- and late-line therapy, palliative care, supportive care, and participation in clinical trials of newer drugs, resulting in poor survival outcomes. The study showed that the 5-year OS rate was 17% and 31% for patients who received non-salvage and salvage regimens, respectively; After salvage therapy, the 5-year OS rates were 46% and 18% for patients with and without ASCT, respectively. Patients who were refractory to second- or second-line therapy and relapsed ≤ 12 months after ASCT had median OS of 6.1 months and 6.2 months, and 2-year OS rates of 17 and 19 percent, respectively. Patients with DLBCL who have ≥ two recurrences/progression are extremely limited, and can only receive salvage therapy such as allogeneic hematopoietic stem cell transplantation (allo-SCT) or enrollment in clinical trials and CAR-T therapy, and there is an urgent need for new drugs or treatments including ADCs and bispecific antibodies to be applied in clinical practice to prolong the survival time of patients and improve their quality of life.
Q3
At the CSCO Annual Meeting, you shared the "DLBCL Whole Process Management Strategy", the whole process management of DLBCL is very important to improve the prognosis of patients, what guidance and suggestions do you have for the whole process management of DLBCL?
Prof. Zhiming Li: DLBCL is the most common type of lymphoma in clinical practice, accounting for about 50% of non-Hodgkin lymphoma (NHL). Among them, the prognosis of R/R DLBCL patients is usually poor, and the treatment methods are relatively limited, and the treatment of these patients is a huge clinical challenge. The 5-year OS rate of lymphoma patients in United States and Japan was reported to be 68.1% and 57.3%, respectively, while the 5-year OS rate of mainland lymphoma patients was only 38.4%. Continental lymphoma patients mainly have problems such as high misdiagnosis rate, poor treatment and follow-up compliance, and the current situation of patients receiving standardized treatment is not ideal. Lymphoma has both the characteristics of chronic disease and tumor, so the whole process of lymphoma patient management is particularly important.
In the whole process of managing patients with DLBCL, it is necessary to be patient-centered, deeply understand the characteristics of the disease and the needs of patients, and improve the understanding of the disease, so as to drive treatment. At the same time, it keeps up with international treatment trends and innovates and optimizes to provide patients with safer and more effective treatment options, and improves treatment selection and treatment sequence according to the changes in underlying diseases. In addition, it is necessary to formulate a more scientific and reasonable treatment path based on the guidance of guidelines, so that patients can receive standardized treatment. "Adhere to the people-oriented, pay attention to the whole process of management, and always make high-quality products" is one of the treatment concepts that the lymphoma team of Sun Yat-sen University Cancer Hospital has adhered to from beginning to end, which not only needs to run through the whole process from disease diagnosis to prognosis management, and transform DLBCL treatment into a chronic disease health management, but also needs to effectively transmit the diagnosis and treatment plan to the prefecture-level hospitals with the help of the upper and lower linkage, so as to ensure that patients can still receive continuous standardized diagnosis and treatment after being discharged from the hospital and return to the grassroots level, and help patients move towards cure.
Q4
With the continuous development of new drugs in recent years, can you share the development prospects of new drug combination therapy in the field of DLBCL, as well as potential hot research directions in the future?
Prof. Zhiming Li: In recent years, the therapeutic progress in the field of DLBCL has mainly focused on the field of targeted and immunotherapy, including ADCs (e.g., CD79b vepotuzumab, ROR1-targeted ADCs), bispecific antibodies (e.g., gefituzumab, Epcoritamab, etc.) and the continuous development of CAR-T cell therapy, all of which have brought a new dawn of cure to DLBCL patients. The combination of targeted therapy and immunotherapy is an important direction for future research and development. The development trend of DLBCL treatment strategy is changing from monotherapy to combination therapy, and the above-mentioned combination therapy methods are also advancing from post-line therapy to front-line treatment, and the no-chemotherapy/light chemotherapy regimen based on the combination of ADC drugs and bispecific antibodies is a hot issue of international concern.
On the 9th anniversary, share "My Story with the Doctor" and receive a customized gift package!
We sincerely invite the participating doctors of this CSCO conference to talk to the medical partners in the venue/booth, and talk to us about the stories of "me and the medical community" and "me and CSCO" in the interview room, and leave your expectations and blessings for the doctor station, and you can get a customized gift!
(Booth Location: Straits Grand Theatre B8, West Gate Entrance Booth T25)
Expert Profile
Professor Li Zhiming
- Chief physician, professor and doctoral supervisor of Sun Yat-sen University Cancer Prevention and Treatment Center
- Chairman of the Tumor Immunotherapy Professional Committee of the Chinese Geriatric Health Care Association
- Deputy Secretary-General and Standing Committee Member of the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology (CSCO).
- Member of the Standing Committee of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association
- Member of the Standing Committee of the Head and Neck Oncology Expert Committee of the Chinese Society of Clinical Oncology (CSCO).
- Secretary-General and Standing Committee Member of the Lymphoma Professional Committee of the Chinese Geriatric Health Care Association
- Chairman of the Lymphoma Professional Committee of Guangdong Anti-Cancer Association
- Chairman of the Professional Committee of Comprehensive Treatment of Head and Neck Tumors of Guangdong Provincial Association of Clinical Medicine
- 主持国家自然科学基金7项，以（共同）通讯或（共同）第一作者在Ann Oncol，Signal Transduction and Targeted Therapy，Autophagy，Cell Rep，J Hematol Oncol，J Immunother Cancer，Blood Adv等杂志发表文章，获得省部级一等奖3项和二等奖1项
- Sun Yat-sen University Cancer Center ranked first in the number of expert outpatient clinics, and won the titles of "The First Hurun China Good Doctor List", "2021 People's Good Doctor Special Contribution", and "2023 (9th) People's Good Doctor".
Resources:
[1] Smith SM. Treatment of aggressive B-cell lymphomas. Hematol Oncol. 2017; 35 Suppl 1:84-87.
[2] Maurer MJ, et al. Ann Oncol. 2018 Aug 1; 29(8):1822-1827.
[3] Zhang Xi, Huang Ruihao. Journal of the Third Military Medical University,2021,43(21):2271-2275.
[4] Sauter CS, Matasar MJ, Meikle J, et al. Blood. 2015; 125:2579–2581.
[5] Armand P, Welch S, Kim HT, et al. Br J Haematol. 2013; 160:608–617.9.
[6] Wang S, et al. Cancer Commun (Lond). 2021; 41(3):229-239.
[7] Arboe B, et al. Clin Epidemiol. 2019 Mar 4;11:207-216.
[8] Crump M, et al. Blood. 2017 Oct 19; 130(16):1800-1808.
[9] NCCN Clinical Practice Guidelines in Oncology. B-cell lymphomas. V1.2022.
Exciting information is waiting for you
Audit Expert: Professor Li Zhiming
Editor in charge: Sheep
*The medical community strives to publish professional and reliable content, but does not make any commitment to the accuracy of the content; The parties involved are invited to separately check when adopting or using this as a basis for decision-making.