A phase II clinical study on a trimodality therapy (START-FIT), conducted by the Departments of Surgery and Clinical Oncology, School of Clinical Medicine, University of Hong Kong (HKUMed; Hong Kong), has found that nearly 50% of patients with inoperable, locally advanced liver cancer, can be cured through this approach, which includes stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE). The results have been published in The Lancet Gastroenterology and Hepatology.
A total of 33 patients were screened and enrolled in this treatment method from March 2019 to January 2021, for tumour diameter ranging from 5 to 17.5cm. Just under two thirds (64%) of patients had tumours with major vascular invasion that precluded them from a curative surgical procedure. The research team developed a new approach termed ‘reduce and remove’—a trimodality therapy (START-FIT)—for these 33 patients. Patients received TACE on day one for local tumour control, followed by SBRT on day 28, and then immunotherapy administered 14 days following SBRT and every two weeks thereafter. This trimodality approach is to downstage the tumour status so that it is amenable to curative surgical intervention.
After this trimodality therapy, 55% (18 patients) became suitable to receive curative surgery, of whom four patients (12%) underwent this surgery, and 14 patients (42%) had complete tumour necrosis and are receiving ongoing monitoring with regular scans. After up to 2.5 years of follow-up, two-year survival among these patients exceeded 90%, with mild side effects experienced throughout the treatment process. The advantages of this approach are that it is minimally invasive with a short hospital stay and a relatively high safety profile.
This treatment strategy provides the opportunity for curative surgery with promising long-term outcomes to patients who would otherwise be unsuitable. “This treatment strategy provides a definite treatment schedule. Most patients could have an idea on the treatment effect within six months after the start of treatment and be able to have better planning for themselves and their family. Now the team is looking forward to expanding the treatment coverage to more patients, especially those with poor liver function, to help downstage the tumour status and hence, increase the chance of fitting into the criteria for liver transplantation in the future.” This statement was shared by Albert Chan Chi-yan, clinical professor at HKUMed’s Department of Surgery at the School of Clinical Medicine, who initiated this world-first trimodality therapy.