On July 30, 2025, Dr. Lee Yu-chung, a clinical oncologist at the Hong Kong United Oncology Centre (HKUOC), was invited to speak at an internal health education seminar hosted by AIA, where he discussed new trends in lung cancer treatment, breast cancer treatment, and prostate cancer treatment. This article is for health education purposes only; actual treatment must be determined by a doctor based on individual circumstances.

Lecture Background

Date:July 30, 2025
Organized by:AIA Internal Health Education Sharing Session
Speaker:Dr. Li Yu Chung, Jacky (Specialist in Clinical Oncology, Hong Kong United Cancer Centre, HKUOC)
purpose：Organize the recent clinical highlights of lung cancer, breast cancer and prostate cancer in an evidence-based and neutral manner.

Speaker Introduction: Dr. Li Yu Chung, Jacky (Hong Kong United Cancer Centre, HKUOC)

Qualifications and expertise

Specialist in Clinical Oncology
Bachelor of Medicine and Bachelor of Surgery, The University of Hong Kong — MBBS (HK)
Fellow of the Royal College of Radiologists of the United Kingdom — FRCR (UK)
Fellow of the Hong Kong College of Radiologists — FHKCR
Fellow of the Hong Kong Academy of Medicine (Radiology) — FHKAM (Radiology)

Clinical focus and scope of concern

胸腔腫瘤（包括Lung cancer）、乳腺腫瘤、泌尿系腫瘤（包括前列腺癌）
The clinical application of modern radiotherapy techniques is integrated with systemic treatment (such as image-guided radiotherapy, IMRT/VMAT, SBRT, etc.).
Evidence-based personalized treatment planning and multidisciplinary team collaboration.

Clinical concepts

Emphasis should be placed on patient education and risk-benefit communication, and treatment plans should be developed under the premise of safety and clinical needs.
Respecting patient preferences and life goals, emphasizing continuous follow-up and interdisciplinary coordination

Brief Highlights

Staging and molecular/receptor testing will influence the treatment plan (surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy, ADC, etc.).
Lung cancer：早期可手術；不宜手術者常用 SBRT。局部晚期多為放療合併全身治療。轉移期依基因或蛋白表現個人化選擇。
Prostate cancer: Intermediate and high-risk patients often receive androgen therapy; eligible patients in the metastatic stage may consider 177Lu-PSMA.
Prostate cancer: Intermediate and high-risk patients often receive androgen therapy; eligible patients in the metastatic stage may consider 177Lu-PSMA.
Any plan has a risk of side effects; if warning symptoms appear, you should seek medical attention as soon as possible.

Why is "staging + molecular/receptor testing" necessary?

Staging determines the main treatment approach (surgery, radiotherapy, or systemic therapy).
Examples of tests include EGFR, ALK, HER2, ER/PR, and PSMA performance, which directly affect the suitability of targeted therapy, immunization, or ADC.
It is recommended to confirm with your doctor before making a treatment decision: Is it necessary to do additional pathology or gene/receptor testing?

Lung cancer: Patient Focus

Early days：Surgery is the primary treatment; for those who are not suitable for surgery, stereotactic body radiotherapy (SBRT) may be considered.
Locally advanced disease: Treatment typically involves radiotherapy, sometimes combined with chemotherapy or immunotherapy depending on the circumstances.
Transfer period (personalized option):
- Targeted therapy: targeting mutations in driver genes such as EGFR and ALK.
- Immunotherapy: PD-1/PD-L1 inhibitors, taking into account PD-L1 expression and physical condition.
- Antibody-drug complex (ADC): Trastuzumab, deruxtecan, etc. may be considered for some HER2-mutant patients.
- Oligometastatic lesions: SBRT may be added to help with local control (assessed by the medical team).
Common side effects (examples): fatigue, rash, decreased blood cell counts; immunotherapy and some ADCs may cause lung inflammation (cough, shortness of breath, fever).

Breast cancer: Patient Focus

Classification: HER2-positive, triple-negative (TNBC), hormone receptor-positive (HR+); some patients may exhibit different receptor profiles simultaneously.
Preoperative treatment (Neoadjuvant):
- HER2 positive: chemotherapy combined with dual-targeted therapy is a common practice; adjustments are made postoperatively based on pathological response.
- Triple-negative (TNBC): Chemotherapy is the primary treatment; whether to add immunotherapy is determined by the physician.
New trends：
- ADCs (such as trastuzumab deruxtecan, T-DXd) offer new options for certain patients who are HER2 positive or HER2-low.
- HR+ metastatic patients commonly receive "endocrine therapy + CDK4/6 inhibitors".
Common side effects (examples): Nausea, decreased white blood cell count; some medications may affect the heart or lungs and require regular monitoring.

Prostate cancer: Patient focus

Localized/Locally Advanced: Surgery or radiotherapy; in moderate-to-high risk cases, this is often combined with androgen deprivation therapy (ADT), or, if appropriate, with a new generation of oral antiandrogen drugs.
Transition Period: For eligible patients, radioactive ligand therapy (177Lu-PSMA) may be considered; this requires prior PSMA imaging assessment and review of treatment history.
Common side effects (examples): hot flashes, fatigue, effects on sexual function and bone health; your doctor will plan for bone health and side effect management concurrently.

FAQ

Am I suitable for immunotherapy for everyone?: No. It will be assessed based on tumor type, PD-L1 expression, comorbidities (such as autoimmune diseases), and overall condition.
What is an ADC?: Antibody-drug complexes: These link targeted antibodies to chemotherapy drugs, delivering the drugs more effectively to tumor cells. Their suitability depends on the tumor's receptor or gene expression.
What is SBRT?: Stereotactic radiotherapy uses a higher single dose and fewer sessions to precisely irradiate the tumor while minimizing the dose to surrounding tissues.
What is 177Lu-PSMA?: A radioligand therapy targeting PSMA; assessment is required to determine if PSMA expression is present and if the criteria are met.

Three questions to prepare before seeing a doctor

What pathology or gene/receptor tests do I need to do?
What is my treatment goal (cure, control, and relieve symptoms)?
The benefits, common side effects and follow-up arrangements of each feasible plan?

Case sharing

Case A | Lung cancer, HER2 mutation, male (50 years old)
- The disease started as stage IIIA; the patient underwent lobectomy, adjuvant chemotherapy, and thoracic radiotherapy; subsequently, lung and liver metastases occurred.
- The management process includes: SBRT for multiple lesions, systemic chemotherapy combined with immunotherapy, selective internal radiotherapy of the hepatic artery (Y-90 SIRT), etc.; emphasizing multimodal treatment and monitoring of adverse reactions (such as radiation pneumonitis).
Case B | A 40-year-old woman with cervical cancer
- Early surgery and pelvic radiotherapy resulted in recurrence in the liver and bone; subsequent immunotherapy (PD-1 inhibitor) and symptom improvement were observed during interim observation, highlighting the importance of biomarkers and supportive care.
Case Study: A 56-year-old female with the C-type EGFR exon 18 variant.
- Disease progression after initial targeted therapy; short-term third-generation EGFR-TKI, combined immunochemotherapy and re-tissue/fluid testing; treatment adjustment after detection of MET amplification and management of specific lesions with SBRT; demonstration of drug resistance mechanism-guided treatment switching and integration of local therapy.

Note: The above cases are only for sharing clinical ideas and do not represent the general efficacy or prognosis; treatment should be determined by the attending doctor on a case-by-case basis.

When should I contact my doctor or seek medical advice as soon as possible?

Persistent fever, shortness of breath or chest pain, severe coughing up of blood, severe or severe pain, jaundice or obvious edema, inability to eat and drink, confusion of consciousness, etc.

Personalized treatment approach of Hong Kong United Cancer Centre (HKUOC)

Patient-centered approach:Maintain appropriate communication with the attending physician, provided that clinical needs and safety are met (e.g., by creating a separate WhatsApp group for non-urgent matters).
Personalized plans:plans are developed based on pathological and molecular results, staging, comorbidities, and personal preferences.
Financial support:Provide medication assistance and clinical research information (if applicable) on a case-by-case basis, without compromising the physician's independent professional judgment.

Inquiries and Appointments (Hong Kong United Cancer Centre HKUOC)

Telephone：+852 2386 8002
WhatsApp：+852 5518 2992
Website:www.hkuoc.hk
Email：Enquiry@hkuoc.hk
Address：Rooms 01–06, 20th Floor, 238 Nathan Road, Jordan, Kowloon (Jordan MTR Station Exit E)

Professional extension: Key points and data (for further reference)

Description: The following content is an educational outline. Drug selection and indications vary depending on staging, molecular testing, and medical history; some drugs are investigational or used under specific conditions and need to be evaluated by a doctor.

Lung cancer: New trends in treatment

Systemic therapy and immunity
- Summary of dual immunotherapy combined with chemotherapy strategies and clinical evidence: Studies such as POSEIDON (durvalumab + tremelimumab + chemotherapy) have shown survival benefits under specific conditions.
- Considerations for the suitability of PD-1/PD-L1 inhibitors: pathological type, PD-L1 expression, comorbidity and autoimmune risk.
Targets and molecules
- HER2 (ERBB2) mutant populations other than driver genes such as EGFR and ALK: can assess the role and safety of HER2 targets or ADCs (such as trastuzumab deruxtecan, T-DXd).
- Bispecific antibodies: The potential applications of next-generation antibodies such as amivantamab in specific mutant populations (such as EGFR exon20ins) need to be examined based on indications and evidence.
- Anti-angiogenic agents and antibodies: ramucirumab, etc., can be considered in appropriate situations when combined with chemotherapy/immunotherapy.
- New (or improved) chemotherapy regimens: the use of nab-paclitaxel, oral fluorouracil (tegafur/gimeracil/oteracil; TS-1, etc. in specific clinical scenarios.
Radiotherapy
- Surgery is not recommended in the early stages: SBRT/SABR is a mature option; in the mid-to-late stages, integrative radiotherapy emphasizes image guidance and dose control.
- Management of metastatic oligofocal lesions: Selective SBRT can be considered as an auxiliary measure for local control (requires case-by-case MDT discussion).

Breast cancer: Classification and New Trends

Common categories
- HER2 positive, triple negative (TNBC), hormone receptor positive (HR+), etc.; some patients may exhibit different receptor manifestations simultaneously.
Preoperative treatment (Neoadjuvant)
- TNBC/HER2+: Preoperative chemotherapy (HER2+ can be combined with dual-targeted therapy) is used for tumor downstaging and pathological response assessment; postoperative adjuvant therapy is adjusted according to the response.
Antibody-drug complex (ADC)
- The clinical role and safety monitoring (such as interstitial lung disease risk) of T-DXd (trastuzumab deruxtecan) in HER2-positive and HER2-low specific populations.

Prostate cancer: Staging-oriented treatment

Partial (Phase I/II) and late partial (Phase III)
- Surgery or radiation therapy; for suitable patients, radiation therapy is often combined with ADT (androgen deprivation therapy).
- Pre-radiotherapy targeted hormone therapy: The integrated strategy of combining LHRH drugs with novel anti-androgen drugs (such as abiraterone, apalutamide, and enzalutamide) needs to be based on risk stratification and guidelines.
Metastatic (stage IV)
- Castration-sensitive period: Early enhancement (such as abiraterone/enzalutamide/apalutamide or docetaxel) can bring survival benefits.
- Castration resistance phase: 177Lu-PSMA radioligand therapy has shown survival benefit in eligible patients; PSMA imaging evaluation and treatment history review are required first.

Other emerging directions

Proton therapy:In some lesion locations, it is hoped that the dose to dangerous organs can be reduced (depending on the case and resource accessibility).
CAR-T：Empirical evidence has been established for hematologic malignancies; solid tumors (such as breast cancer) are still in the clinical trial stage and more data are needed.

R&D and clinical research pipeline

T-DXd（trastuzumab deruxtecan, ADC）：Anti-HER2 monoclonal antibodies combined with topoisomerase I inhibitors as ADCs; however, safety concerns such as interstitial lung disease should be noted.
BAY 2927088：An oral, reversible HER2/EGFR TKI, selective for mutant HER2/EGFR (in clinical trials).
HLX10：Humanized PD-1 inhibitor; under evaluation in multi-cancer clinical trials.
OP-1250：ER complete antagonist/degrader (development of endocrine therapy for breast cancer).
DB-1303：anti-HER2 ADC releases topoisomerase I inhibitors via cleavable linkers (in clinical trials).

The availability, indications and declaration status of the above drugs are updated according to the region and time; if you need to know about clinical research or funding arrangements, please contact the medical team.

Key points and data

Lung cancer

Combination immunotherapy: Studies such as POSEIDON have shown survival benefits under certain conditions; it needs to be evaluated based on biomarkers and comorbidities.
Molecular targeting: Detection of EGFR, ALK, ROS1, BRAF, METex14, RET, NTRK, KRAS G12C, and HER2 can influence first-line and subsequent strategies.
Radiation therapy integration: techniques such as SBRT/IGRT/VMAT improve accuracy; oligometastatic cases require multidisciplinary consultation for judgment.

breast cancer

HR+/HER2-: CDK4/6 inhibitors combined with endocrine therapy can significantly prolong progression-free survival, and some studies show overall survival benefit.
HER2 positive and HER2-low: ADCs such as T-DXd bring improved PFS/OS and new treatment pathways to carefully selected populations.
Radiation therapy techniques such as DIBH and IMRT/VMAT can reduce cardiopulmonary dose when appropriate.

prostate cancer

Castration-sensitive period: Early reinforcement strategies with abiraterone/enzalutamide/apalutamide or docetaxel have improved overall survival in multiple studies (such as the STAMPEDE program).
Castration resistance period: 177Lu-PSMA-617 (VISION trial) improves OS in eligible individuals; assessment based on PSMA PET/CT is required.
Imaging staging: PSMA PET/CT helps with accurate staging and treatment planning.

Reference (excerpt)

NCCN Clinical Practice Guidelines 2025：NSCLC／Breast／Prostate
ESMO Guidelines 2023–2024：NSCLC／Breast／Prostate
Paz-Ares L, et al. CheckMate-9LA. J Clin Oncol. 2023
Johnson ML, et al. POSEIDON. Lancet Oncol. 2022；J Clin Oncol. 2023
Modi S, et al. DESTINY-Breast04. N Engl J Med. 2022
Cortes J, et al. DESTINY-Breast03. N Engl J Med. 2022
James ND, Parker CC, et al. STAMPEDE. Lancet 2017／2021
Sartor O, et al. VISION（177Lu-PSMA-617）. N Engl J Med. 2021
ASTRO/ESTRO Radiotherapy Consensus and Technical Recommendations (multiple articles)

For more up-to-date information on cancer treatment in Hong Kong, please refer to the following authoritative resources：

Hong Kong Hospital Authority-Cancer Services: Provide official information and resources on local cancer treatment.
Hong Kong Cancer Fund: Free support services and patient education materials.