De-escalation of carboplatin possible in HER2+ breast cancer: Chinese trial

 For patients with low- and moderate-risk HER2-positive breast cancer, carboplatin may be safely omitted from the neoadjuvant regimen without compromising outcomes at surgery, a Chinese trial has shown.

Published in the Journal of Clinical Oncology, the phase III neoCARHP trial results show that neoadjuvant THP for six cycles is noninferior to TCHP in achieving pathologic complete response for stage II-III human epidermal growth factor receptor 2–positive (HER2+) breast cancer, with reduced toxicity.

The trial, led by Professor Gao Hongfei of the Guangdong Provincial People’s Hospital, recruited 776 women age 18 years or older with previously untreated, stage II and III, HER2-positive invasive breast cancer. Patients were randomly assigned (1:1) to receive six 3-week cycles of taxane (docetaxel, paclitaxel, or nab-paclitaxel) plus trastuzumab and pertuzumab, with carboplatin (TCbHP) or without carboplatin (THP).

The primary end point was pathologic complete response (pCR) rate in the breast and axilla (ypT0/is ypN0).

The trial met its primary end point, with pCR rates of 64.1% for THP versus 65.9% for TCHP, meeting the prespecified –10% noninferiority margin (difference, –1.8%.

The results were consistent across hormone receptor–positive (pCR rates 56% v 59%) and hormone receptor–negative (78% v 78%) subgroups, as well as across stage II and III disease and across taxane choices.

Notably, THP demonstrated substantially fewer grade 3-4 adverse events (20.7% v 34.6%) and fewer serious adverse events (1.3% v 4.7%), with marked reductions in anemia, nausea, vomiting, neutropenia, and thrombocytopenia compared with TCHP.

“These findings suggest that omitting carboplatin may serve as an alternative neoadjuvant strategy in combination with dual HER2 blockade for patients with early-stage HER2-positive breast cancer,” the study authors concluded.

The study was conducted at 15 cancer centres in China and led by researchers at Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou.

An accompanying commentary article welcomed the findings but urged caution, noting that although pCR is prognostic at the individual patient level, its surrogacy for survival in treatment comparisons is modest. 

It would therefore be important to await mature data from neoCARHP and related data sets, it advised.

The article also noted that nearly all THP trials enrolled patients with stage II disease, warranting caution in translating their results into practice for patients with stage III disease, for which a more intensive neoadjuvant regimen should be recommended at present.

One in three Chinese cancer papers flagged as paper mill publications

 A machine learning model that can detect paper mill publications should be incorporated into medical journal manuscript screening processes, researchers say.

Almost 10% of cancer papers in medical journals are flagged as coming from paper mills, with China the most common source, a study has found.

Published in the BMJ, the study used a machine learning model to distinguish paper mill publications from genuine cancer research articles, and to screen the cancer research literature to assess the prevalence of papers that have textual similarities to paper mill papers.

When applied to the cancer research literature, the model flagged 261,245 of 2.7 million papers (9.87%).

More than 170,000 cancer papers affiliated with Chinese institutions were flagged, accounting for 36% of Chinese cancer research articles. Flagged papers were overrepresented in fundamental research and in gastric, bone, and liver cancer.

Flagged papers were seen across most medical journal publishers including the top 10% of journals by impact factor. However a small group of medical publishers had higher proportions of flagged papers, with companies such as Verduci Editore, International Scientific Literature, Frontiers and Baishideng having more than 10% of papers flagged.

There was a large increase in flagged papers from 1999 to a plateau in 2022.

The study authors said the higher proportion of flagged papers in gastric and liver cancer research may partly be explained by the high prevalence of these cancers in China.

“Their marked overrepresentation among misidentified cell lines—25% and 15% of all such lines, respectively—is striking,” they wrote.

“Given that some misidentified cell lines, such as BGC-823 and BEL-7402, appear almost exclusively in publications from Chinese institutions, this pattern may also reflect vulnerabilities exploited by paper mills when popular research topics are targeted. Furthermore, this pattern could result from inertia because early templates were reused and adapted repeatedly in these domains.”

They said the rise in the percentage of flagged papers in high impact journals suggested that paper mill papers were not just a problem for low impact journals.

“The concurrent increase in impact factors and the spread of flagged papers suggest that both phenomena may stem from the pressures of the publish-or-perish culture. The increase in flagged papers in high impact factor journals highlights an important limitation of using impact factors as proxies for research quality,” they wrote.

The authors said their model could be deployed by medical publishers to screen submitted cancer related manuscripts for paper mill involvement. The model was already integrated into the online submission systems of three journals from a major publisher, they noted

However they warned that paper mill publishers would be quick to react and innovate as detection methods such as this model threatened their income. The release of ChatGPT and the rise of generative AI might further blur the boundaries between genuine and fabricated texts, rendering future automated detection of fraudulent features more challenging, they predicted.

“While efforts to combat paper mills may evolve into an arms race, this problem has reached an unacceptable scale. Inaction risks allowing paper mills to spread further, potentially compromising entire journals and publishers—as already seen in the case of Hindawi,” they concluded. 

Tributes paid to Sun Yan, the 'founder' of medical oncology in China

Tributes have been paid to Professor Sun Yan, a pioneer of clinical oncology in China, who died on January 24, 2026 at the age of 97.

Sun Yan was the director of Internal Medicine at the Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing for many years and served as the director of the Clinical Research Center for New Drugs.

According to the Chinese Academy of Engineering, Sun Yan became one of the founders of medical oncology treatment in China when he was appointed to work with surgeons and radiation therapy specialists at Beijing’s Ritan Hospital in the 1960s.

The Academy said Professor Sun took the lead in advocating the concept of comprehensive cancer treatment, took the lead in the research and development and clinical trials of novel oncology drugs in China, and actively explored the path of integrated Chinese and Western medicine for prevention and treatment. During his time as head of the oncology department he led nearly 80 clinical trials, and trained more than a thousand oncology internal medicine specialists.

He participated in the development of more than 30 new drugs including N-formyl-lysosarcoma, ectinib, lanxanthene injection and recombinant human endostatin. Among these, the tyrosine kinase inhibitors ectinib was China’s first small molecule targeted anti-cancer drug with nationally independent intellectual property rights. Sun Yan also developed the Traditional Chinese Medicine product Zhenqi Righting to boost bone marrow and immune function as adjuvant treatment of cancer patients after radiotherapy and chemotherapy. The success of the products boosted the local pharmaceutical industry in rural Gansu and lifted the Dingxi, area out of poverty.

A tribute article for Sun Yan was published by the Chinese Collaborative Professional Committee for Clinical Oncology (CSCO), for which Sun Yan was founder and Honorary Chairman. It noted that Sun Yan personally initiated the establishment of CSCO with the goal of promoting unity, pragmatism and collaboration in clinical oncology in China. Following his guidance, the Society now conducts in-depth exchanges and cooperation with international authoritative organisations such as ASCO and ESMO, assists in promoting the integration of international multicentre clinical research and promotes the continuous development of China’s anti-tumour drug research and development,

The Society has cultivated a large number of leading clinicians and created a backbone workforce active at the forefront of the Chinese oncology community.

Sun Yan was born in 1929 and graduated from Beijing Union Medical College in 1956. He joined Beijing Union Hospital in the same year. In 1959, he entered the Cancer Hospital of the Chinese Academy of Medical Sciences.

At this time, when the field of solid tumour research in China was very limited, Sun Yan began to work with Zhou Jichang and other pioneers to create China’s first tumour chemotherapy group. Starting with five hospital beds, he built the first foundations of medical oncology in China.

In 1979 Professor Sun went to the MD Anderson Cancer Center in the United States to study, and was later appointed as a visiting professor. He continued international collaborations, fostering strong links with professional groups such as ASCO, whose annual meetings he attended on a regular basis to provide updates on oncology in China.

In the 1980s, Professor Sun tackled the lack of standardised standards in the field of clinical trials of new anti-cancer drugs in China. As the director of the National Clinical Research Center for New Drugs (Antitumour Drugs), he led the formation of a professional review team, drafting the first edition of the “Clinical Research Specifications for New Antitumour Drugs”, and delineated the regulations for clinical trials of new drugs, with a priority on ensuring patient safety.

In the 1990s he continued to develop a workforce of new oncology drug R&D personnel and clinicians, and to promote an anti-tumor drug clinical trial quality management specification (GCP) training course. At the same time he was at the international forefront of clinical trials of new anticancer drugs.

Professor Sun also led the collaborative efforts of a number of top hospitals across China to optimise combined chemotherapy regimens, with a focus on improving treatment and outcomes for patients with advanced non-small cell lung cancer.

“Your life was the most perfect interpretation of benevolence and benevolence and the sincerity of the great doctor,” said Dr Li Zhiming, director of the Department of Oncology at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, a in a tribute article.

Professor Li highlighted Sun Yan’s leadership in the organisation of the national investigation of cancer causes of death, and his development of the first “Atlas of Malignant Tumours”, as well promoting the construction of a disciplinary system.

The Cancer Hospital of the Chinese Academy of Medical Sciences wrote in an article in memory of Sun Yan noting that he carefully nurtured younger colleagues and made outstanding scientific research achievements.

“Comrade Sun Yan’s life is a life of dedicated service to the cause of oncology medicine in our country,” it said.

Timing of cancer therapy may influence outcomes

Researchers in Hunan have shown that patients with advanced lung cancer who received immunochemotherapy before 3pm have a more delayed disease progression than patients receiving treatment later in the day, .

The findings, published as part of a randomised phase 3 trial of 210 participants in Nature Medicine nature.com/articles/s41…, suggest that scheduling therapy early in the day may offer a simple, cost-neutral way to enhance standard care.

Circadian rhythms, the internal 24-hour clock, are known to affect immune cell behaviour and responses to treatment. Previous retrospective studies across cancers, such as kidney cancer and malignant melanoma, have hinted that administering immune checkpoint inhibitors earlier in the day might be more effective. However, prospective randomised controlled trials to validate these preliminary findings have been lacking.

Dr Zhang Yongchang and colleagues at the Central South University, Changsha, conducted a randomised phase 3 study involving 210 patients with advanced non–small-cell lung cancer who have not received any treatment (treatment-naïve).

Patients were assigned to receive immunochemotherapy either before 15:00 (early group) or at or after 15:00 (late group) for the first four treatment cycles. 

After a median follow-up of approximately 28.7 months, the early group did not experience their cancer worsen (progression-free survival) for an average of 11.3 months, versus 5.7 months for the late group.

Median overall survival was 28.0 months in the early group and 16.8 months in the late group. Treatment response rates were 69.5% in the early group and 56.2% in the late group, and there were no significant differences in immune-related adverse events.

Through further analysis, the authors also observed more CD8⁺ T cells circulating in the blood (a type of immune cell) and a higher ratio of activated to exhausted CD8⁺ T cells in the early group than in the late group, which could explain higher therapy efficacy in this group.

“In summary, our study indicates that early ToD immunochemotherapy substantially improves PFS and OS and is associated with enhanced antitumor CD8+ T cell characteristics compared with late ToD treatment.”

The authors say that the mechanistic pathways linking circadian timing to efficacy in patients also require further investigation.

Camrelizumab shows durable overall survival benefits in nasopharyngeal carcinoma

by Michael Woodhead

 Adding the immune checkpoint inhibitor camrelizumab to chemotherapy improves five-year overall survival when compared to chemotherapy alone as first-line treatment of patients with recurrent or metastatic nasopharyngeal carcinoma (RM-NPC), a randomised controlled trial led by Guangdong researchers has confirmed.

PD-1 inhibitors plus chemotherapy are already the current standard first-line treatment of recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) but their long-term survival benefits was uncertain, according to researchers, led by Professor Yan Huang from Sun Yat-sen University Cancer Center, Guangzhou, writing in JAMA Oncology.

To investigate long term survival rates, they conducted a secondary analysis of CAPTAIN-1st study, a randomised, double-blind, phase 3 trial conducted at 28 hospitals in China that involved 263 patients with RM-NPC.

In the trial, patients were randomised to receive camrelizumab or placebo in combination with gemcitabine and cisplatin for 4 to 6 cycles, followed by maintenance therapy with camrelizumab or placebo until disease progression, unacceptable toxic effects, or completion of two years of treatment.

Their results showed that after follow up of around 63 months, the addition of the PD-1 inhibitor to chemotherapy was associated with a “clinically meaningful” 35% reduction in deaths, with an eight month improvement in 5-year overall survival compared with chemotherapy alone.

The median overall survival at five years was 34.5 months (95% CI, 29.4-45.7) with camrelizumab vs 26.6 months (95% CI, 19.8-33.5) with placebo. The overall hazard ratio [HR] was 0.74, but after adjusting for age imbalance the HR was 0.65 (95% CI, 0.48-0.89; P = .01).

The overall five-year OS rates were 37.8% vs 24.2%, reflecting an absolute difference of 13.6% (95% CI, 2.4%-24.8%; P = .02) in favour of camrelizumab.

The study researchers noted that the OS benefits were generally consistent across subgroups. They also observed that rapid clearance of plasma Epstein-Barr virus DNA was a valuable prognostic biomarker of long-term survival, with a hazard ratio of 0.32; for give year overall survival patients in the camrelizumab group who achieved rapid clearance of EBV DNA compared with those without EBV DNA clearance

“These findings provide the first 5-year evidence to inform clinical practice on programmed cell death 1 protein–based chemoimmunotherapy in RM-NPC, supporting camrelizumab plus chemotherapy as the standard first-line treatment and establishing a new benchmark for long-term survival in this population,” the authors concluded.

This study was funded by Jiangsu Hengrui Pharmaceuticals, which markets camrelizumab under the brand name AiRuiKa. Camrelizumab is currently approved for nine indications in China, including nasopharyngeal carcinoma, HCC, relapsed/refractory classic Hodgkin’s lymphoma and oesophageal squamous cell carcinoma.