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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.
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.
Cercek's dostarlimab study is the clearest demonstration that immunotherapy can replace surgery in a solid tumour: patients with dMMR rectal cancer can keep their rectum and avoid the permanent effects of pelvic radiotherapy and surgery. Non-operative management after PD-1 blockade is now in guidelines for this group, and MMR testing before treatment of rectal cancer is essential. The approach applies only to the 5-10% of rectal cancers that are dMMR.
Two bottleneck pages and 13 idea pages on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
Shares AZUR-1, Cercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency, Dostarlimab, Surgery and radiotherapy cure most, get least.
Shares AZUR-1, Dostarlimab, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, A permanently funded international network for randomised cancer surgery trials, Surgery and radiotherapy cure most, get least, Head and neck squamous cell carcinoma.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, A permanently funded international network for randomised cancer surgery trials, Surgery and radiotherapy cure most, get least, Colorectal cancer.
Shares Myriam Chalabi, Study of Perioperative Dostarlimab in Participants With Untreated T4N0 or Stage III dMMR/MSI-H Resectable Colon Cancer, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, A permanently funded international network for randomised cancer surgery trials, Surgery and radiotherapy cure most, get least, Toxicity and quality of life are undervalued.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, A permanently funded international network for randomised cancer surgery trials, Surgery and radiotherapy cure most, get least.
Shares AZUR-1, Cercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency, Dostarlimab, Colorectal cancer.