Patients as pioneers: A doctor changes cancer research in China

BEIJING — The patient had tried everything. Standard chemotherapy. Radiation. Multiple surgeries. Nothing worked.

When his family came to see him at Beijing Cancer Hospital, they were out of options — and out of hope.

Then a renowned gastric cancer surgeon, Ji Jiafu, offered something at the cutting edge of research: a clinical trial in which the patient could receive a drug that seemed promising in the laboratory but which had not been tested in the real world.

"They were scared," Ji recalled. "They asked me: 'Doctor, are you going to use our father as a test subject?'"

It's a question Ji has heard countless times over his 25-year career, and it's the biggest challenge he has faced — not in the operating room, but in changing the way people think.

The drug that patient received through the trial is now part of standard care across Asia. The research behind it — led by Ji's team — has been published in the world's top medical journals and has altered the way gastric cancer is treated around the world.

Achieving trust

When Beijing Cancer Hospital became one of China's first national drug testing centers in 1999, the words "clinical trial" carried heavy baggage.

"Many people thought we were experimenting on patients," Ji said, sitting in his office between surgeries. "That's the biggest misunderstanding we face."

The stigma was not entirely unwarranted. In the early days, some hospitals did run trials with questionable ethics. But Ji was determined to build something different — an institution where patient safety came first, where research served care rather than the other way around.

It took 25 years, but today Beijing Cancer Hospital coordinates more than 400 clinical trials annually. Patients actively ask about trial options. And Chinese research is no longer just following Western studies, it's leading them, Ji said.

For decades, international cancer treatment guidelines were written almost entirely by Western researchers. This was particularly problematic for gastric cancer — a disease that strikes Chinese people at a high rate. Nearly half the world's patients are in China.

"How can guidelines for a disease that predominantly affects Asians be written based on Western populations?" Ji asked. "It didn't make sense."

So Ji and his team set out to generate Chinese data that the world couldn't ignore.

The CLASS-01 study was the first large-scale trial proving that minimally invasive laparoscopic surgery could safely treat advanced gastric cancer. After it was published in the prestigious journal JAMA, it became standard practice worldwide.

Another study went further. Over 10 years, Ji's team followed 1,094 patients across 27 hospitals. The results showed that a chemotherapy approach called SOX improved five-year survival rates from 52.1 percent to 60 percent.

"Eight out of every 100 patients lived because of this research," Ji said. "That's not just a statistic. Those are fathers, mothers, grandparents."

The SOX regimen has since been adopted by the world's most influential cancer organizations. It could become the standard local treatment for advanced gastric cancer across Asia.

Three lessons learned

Building a world-class clinical trial institution wasn't easy. Ji identified three fundamental changes that made the difference:

• Research must be part of care, not separate: "Clinical trials shouldn't be an island," he said. At his hospital, doctors consider trial options starting with a patient's first visit. It's not an afterthought, it's a potential lifeline.

• Dedicated teams matter. In 2014, the hospital established China's first full-time clinical trial medical team for Phase I clinical trials — doctors, nurses and technicians who focus exclusively on research. "These are not regular doctors doing trials on the side," Ji said. "This is their profession." From 2016 to 2018, the hospital led the nation in Phase I trial volume.

• Technology should serve both patients and science. Electronic medical records were designed from the start to support both care and research data quality. Today, all trial approvals are completed online, with average startup times of 15 to 20 weeks — among the fastest in China.

The human element

Despite scientific advances, fear of clinical trials persists in China and worldwide. Ji has developed a simple explanation he shares with every family considering a trial.

"A clinical trial is scientifically verifying whether a new treatment is safe and effective before it's widely used," he said. Every trial undergoes strict ethical oversight. Patients can withdraw at any time without penalty. Study medications are free. Monitoring is intensive — far more than standard care.

Why should patients consider participating? Ji offered three words: Hope. Benefit. Contribution.

Hope, because trials offer access to cutting-edge treatments unavailable through standard care. Benefit, because participants receive closer medical monitoring and often achieve outcomes equal to or better than non-participants. Contribution, because every participant helps validate treatments that will benefit future patients.

"This is a love that transcends the individual," Ji said.

From follower to leader

China's clinical research landscape is evolving rapidly. Recent work like the COMPASSION-15 study, published in Nature Medicine, demonstrated the effectiveness of a domestically developed immunotherapy drug for gastric cancer. It showed Chinese innovation at the forefront.

"Chinese research is moving from following to leading," Ji said. "In the future, we will see increasingly high-level evidence from China in international guidelines. This is the trend of the times."

But for all the publications and guidelines, Ji's focus remains on the human element — the patients who walk through his door every day, often with nowhere else to turn.

"Every patient who joins a trial is making a choice that helps strangers they'll never meet," he said. "They're not numbers, they're pioneers. And they are changing medicine for all of us."

It's a transformation 25 years in the making. And it positions China at the frontier of global cancer research — not by following the lead of others but by generating the evidence the world needs.