A funded programme of organ-preservation trials to avoid radical surgery
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.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
Pages like this
not linked directly; found by shared links- Key paperDostarlimab alone cures mismatch-repair-deficient rectal cancer without surgery or radiotherapy
Shares Dostarlimab, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative, Surgery and radiotherapy cure most, get least.
- Key paperCercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency
Shares Dostarlimab, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Surgery and radiotherapy cure most, get least, Toxicity and quality of life are undervalued.
- TrialNICHE-2
Shares Myriam Chalabi, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative, Colorectal cancer.
- Key paperNICHE-2: a month of nivolumab and ipilimumab before surgery clears mismatch-repair-deficient colon cancer in most patients
Shares Myriam Chalabi, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative, Surgery and radiotherapy cure most, get least.
- PairingNeoadjuvant checkpoint inhibitor → surgery (or no surgery) in dMMR colorectal cancer
Shares Dostarlimab, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative, Colorectal cancer.
- IdeaProtect hearing from cisplatin in adults as we now do in children
Shares Bladder & urothelial cancer, Toxicity and quality of life are undervalued, Head and neck squamous cell carcinoma.
- TrialAZUR-1
Shares Dostarlimab, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Colorectal cancer.
- IdeaA pragmatic trial network for intraoperative margin tools, paid on margin reduction
Shares A permanently funded international network for randomised cancer surgery trials, Surgery and radiotherapy cure most, get least, Head and neck squamous cell carcinoma.