{"entity":{"id":"idea-fund-organ-preservation-programme","kind":"idea","name":"A funded programme of organ-preservation trials to avoid radical surgery","aka":[],"tldr":"For some cancers, drugs and radiotherapy can now cure without removing the organ, sparing patients a stoma, a lost voice or a removed bladder. A dedicated programme would run the trials to prove where this is safe.","summary":"A trials programme testing non-operative and organ-preserving strategies against standard radical surgery: watch-and-wait after total neoadjuvant therapy in rectal cancer, immunotherapy-only in mismatch-repair-deficient tumours (following the dostarlimab rectal cancer results), bladder preservation with chemoradiotherapy and immunotherapy, larynx preservation, breast surgery omission after exceptional response, and oesophageal active surveillance. These trials are hard to fund because they remove a procedure rather than add a drug, but their quality-of-life value is large. The programme would include patient-reported outcomes and survivorship endpoints as co-primary, and shared surveillance protocols.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Surgery and radiotherapy cure most, get least): Sullivan et al., Global cancer surgery (Lancet Oncology Commission 2015)","url":"https://doi.org/10.1016/S1470-2045(15)00223-5"}],"tags":[],"related":["idea-fund-surgical-trials-network","idea-fund-omission-deescalation-trials"],"cancers":["colorectal","urothelial","head-and-neck","esophageal"],"sections":[],"technologies":[],"targets":[],"drugs":["dostarlimab","pembrolizumab"],"companies":[],"institutions":[],"pathways":[],"terms":["msi","neoadjuvant-adjuvant"],"trials":["azur-1","nct05855200","nct06062420","nct06256588","nct06567782"],"people":["myriam-chalabi"],"bottlenecks":["b-surgery-radiation-innovation","b-toxicity-qol"],"keyPapers":["paper-cercek-dostarlimab-rectal-nejm-2022","paper-sullivan-lancet-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A dedicated programme completes at least five randomised or well-controlled organ-preservation trials within seven years, at least three of which establish non-inferior survival with substantially better patient-reported function, changing guidelines in those indications.","rationale":"The OPRA and dostarlimab rectal cancer studies, the bladder-preservation trimodality data and the larynx-preservation trials show the biology allows organ preservation in selected patients; the barrier is the trials, which no company will fund and which surgical culture has been slow to run.","test":"Launch three trials in the first two years with pre-registered non-inferiority margins and patient-reported co-primary endpoints; track accrual and publication.","maturity":"being-tested-at-scale","actor":"research","cost":"large","horizonYears":5},"route":"/ideas/idea-fund-organ-preservation-programme/","neighbours":{"idea":[{"id":"idea-fund-surgical-trials-network","kind":"idea","name":"A permanently funded international network for randomised cancer surgery trials","route":"/ideas/idea-fund-surgical-trials-network/"},{"id":"idea-fund-omission-deescalation-trials","kind":"idea","name":"Payer-funded trials that omit surgery or radiotherapy in low-risk patients","route":"/ideas/idea-fund-omission-deescalation-trials/"}],"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"}],"drug":[{"id":"dostarlimab","kind":"drug","name":"Dostarlimab","route":"/drugs/dostarlimab/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"term":[{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"},{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"trial":[{"id":"nct06062420","kind":"trial","name":"A Platform Study of Novel Immunotherapy Combinations as First-Line Treatment in Participants With PD-L1 Positive Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck- GALAXIES H&N-202","route":"/trials/nct06062420/"},{"id":"nct06256588","kind":"trial","name":"A Study of Dostarlimab vs Placebo After Chemoradiation in Adult Participants With Locally Advanced Unresected Head and Neck Squamous Cell Carcinoma","route":"/trials/nct06256588/"},{"id":"nct06567782","kind":"trial","name":"A Study of Neoadjuvant Dostarlimab Plus Capecitabine Plus Oxaliplatin (CAPEOX) Vs CAPEOX With Previously Untreated T4N0 or Stage III Mismatch Repair Proficient (MMRp)/Microsatellite Stable (MSS) Colon Cancer","route":"/trials/nct06567782/"},{"id":"azur-1","kind":"trial","name":"AZUR-1","route":"/trials/azur-1/"},{"id":"nct05855200","kind":"trial","name":"Study of Perioperative Dostarlimab in Participants With Untreated T4N0 or Stage III dMMR/MSI-H Resectable Colon Cancer","route":"/trials/nct05855200/"}],"person":[{"id":"myriam-chalabi","kind":"person","name":"Myriam Chalabi","route":"/people/myriam-chalabi/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-cercek-dostarlimab-rectal-nejm-2022","kind":"paper","name":"Cercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency","route":"/key-papers/paper-cercek-dostarlimab-rectal-nejm-2022/"},{"id":"paper-sullivan-lancet-oncol","kind":"paper","name":"Global cancer surgery: delivering safe, affordable, and timely cancer surgery","route":"/key-papers/paper-sullivan-lancet-oncol/"}]}}