Researchers at the University of Hong Kong's Faculty of Medicine have published groundbreaking long-term data demonstrating that a novel combination treatment approach achieves complete cancer remission in nearly half of patients with advanced liver cancer. The study, published in JAMA Oncology, represents the first comprehensive investigation into long-term outcomes for patients receiving combined locoregional therapy and immunotherapy (LRT-IO) for locally advanced unresectable liver cancer.
Treatment Protocol Shows Sustained Efficacy
The interdisciplinary research team, led by Professor Albert Chan Chi-yan from the Department of Surgery and Dr. Chiang Chi-leung from the Department of Clinical Oncology, monitored 63 patients with locally advanced unresectable liver cancer treated between January 2018 and December 2022. The innovative "cocktail" strategy combines stereotactic beam radiotherapy (SBRT) with optional transarterial chemoembolisation (TACE), followed by immunotherapy.
During a median follow-up period of nearly three years, 29 patients (46%) achieved complete response, with two-thirds remaining cancer-free at the data cutoff in June 2023. The median tumor size in the study population was 10 centimeters, representing particularly challenging cases typically considered incurable.
Survival Outcomes Match Surgical Standards
The survival data revealed striking differences between treatment responders and non-responders. Patients achieving complete response demonstrated a three-year overall survival rate of 76% compared to 28% in those without complete response—a more than two-fold improvement. Notably, the survival outcomes for complete responders were comparable to those achieved through curative surgery, the current gold standard for liver cancer treatment.
"Our study provides long-term data that confirms our previous findings: the LRT-IO approach is a potentially curative treatment for large, unresectable liver cancer, with a 46% complete response rate, and a 75% survival among patients who achieved a complete response," explained Dr. Chiang Chi-leung.
Recurrence Management and Surgical Conversion
While approximately one-third of patients experienced cancer recurrence, the study revealed that 60% of these patients became eligible for curative surgery as a primary treatment option. This finding highlights the potential of LRT-IO to convert initially inoperable tumors into surgically resectable disease, expanding treatment possibilities for patients previously considered beyond curative intervention.
Clinical Practice Implications
The research establishes the viability of a "watch-and-wait" strategy for patients achieving complete response to LRT-IO treatment. This approach offers particular value for elderly patients, those medically unfit for surgery, or cases involving anatomically challenging tumor locations where surgical intervention is not feasible.
The study represents the largest investigation to date examining patients with advanced liver cancer treated with LRT-IO and the first to provide comprehensive long-term outcome data. These findings contribute critical evidence supporting LRT-IO as a safe and effective long-term treatment option for advanced liver cancer.
Regulatory Recognition and Future Implementation
The treatment approach has gained significant recognition within the medical community. In 2024, a similar protocol known as "START-FIT," developed by the same research team, was incorporated into the National Guidelines for the Management of Liver Cancer in China (2024 Edition). The researchers express optimism that the LRT-IO approach will be included in future international guidelines based on this compelling evidence.
"Professor Chan and I have continued to promote the use of this novel treatment in various local and national conferences. There are an increasing number of tertiary centres in Hong Kong that have adopted this LRT-IO strategy in their clinical practice. We hope to generate a guideline in Hong Kong to incorporate such practice in the near future," stated Dr. Chiang.
The research team continues to advocate for broader adoption of this treatment paradigm, with Professor Chan emphasizing their ongoing commitment: "It will always be our passion and mission to explore novel and effective ways to tackle this deadly but common cancer."
This breakthrough offers new hope for patients facing advanced liver cancer diagnoses, transforming what was previously considered an incurable condition into a potentially treatable and even curable disease through innovative combination therapy approaches.
