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Breast Cancer Patients May Not Need Surgery After Complete Response

Surgery may not be necessary for all early-stage breast cancer patients, according to the results of a phase II study published in JAMA Oncology. All 31 participants who skipped surgery were alive without cancer returning in the same breast five years after they were found to have no evidence of cancer cells after chemotherapy and radiation. Surgery has long been a standard for the treatment of early-stage breast cancer, but there are many cases where the cancer is wiped out by systemic treatments like chemotherapy and targeted therapy before surgery is performed. Researchers wanted to know if surgery is really needed for these patients. In the JAMA Oncology study, women with HER2-positive or triple-negative breast cancer who had received neoadjuvant therapy, treatment given before surgery, were treated with radiation therapy. The patients then had cells from the site of the tumor tested using a vacuum assisted biopsy, which found 31 women who had no signs of cancer remaining. Five years after the treatment, there had been no cases of cancer returning to the same breast in these patients. “Our innovative, precise method of detecting cancer in these patients has successfully demonstrated that we can treat them while avoiding surgery for this group,” said Henry Kuerer, a breast cancer surgeon at the University of Texas MD Anderson Cancer Center in Houston, in an article for HealthDay. “The absence of detectable breast cancer recurrences at the five-year mark highlights the tremendous potential of this surgery-free approach to breast cancer management.” Kuerer said the researchers hope the approach will become routine, but further trials will be needed before it becomes an option in standard care.

Imfinzi Approved by FDA for Muscle-invasive Bladder Cancer

The Food and Drug Administration (FDA) announced approval for the immunotherapy drug Imfinzi (durvalumab) as treatment for muscle-invasive bladder cancer. The approval permits the use of Imfinzi with gemcitabine and cisplatin before surgery. After surgery, patients undergo up to eight cycles of Imfinzi alone. The FDA decision was based on results from the phase III NIAGRA trial, presented at the European Society for Medical Oncology (ESMO) Annual Congress 2024, held in Barcelona last September, Oncology News Central reported. The NIAGRA trial found that the addition of Imfinzi to neoadjuvant chemotherapy and surgery led to a 32% reduction in the risk of disease progression, recurrence or death, the ASCO Post reported at the time. Petros Grivas, a medical oncologist at Fred Hutch Cancer Center in Seattle, underlined the impact of the findings in his invited commentary at the ESMO meeting in September, Oncology News Central reported. “This is a practice-changing trial based on the EFS/OS benefit, and I think it should change practice, in my opinion, immediately,” Grivas said.

Colorectal Cancer Screenings in Rural Areas Rise with Mailed Kits

Efforts to improve colorectal cancer screening rates run into challenges with people in rural areas who may not be aware of screening recommendations or face long drives to see a doctor. Looking for ways to overcome these challenges, researchers found that mailing fecal immunochemical tests (FIT) to people in rural areas doubled the likelihood of those people being screened in the next six months. The gold standard for colorectal cancer screening is colonoscopy, which can detect cancer and also find and remove precancerous lesions. But colonoscopy requires preparation and usually involves sedation, making it a challenge for many people to get. FIT detects signs of cancer and can be done at home, with colonoscopy required only if the test reports abnormal results. In a JAMA Network Open study, 14 health clinics in rural Oregon mailed FITs to 2,613 people insured by Medicaid and due for screening. Their results were compared with another 14 clinics serving 3,001 patients that provided the usual care, including offering to schedule screening at checkups and other appointments. The findings showed 11.8% of people mailed FIT completed colorectal cancer screening of any kind in the next six months, compared with 4.5% of the usual care group. More participants in the group that was mailed tests reported for follow-up colonoscopies after abnormal results, but researchers found the difference between the groups was not statistically significant, meaning they couldn’t determine whether the difference was the result of chance. “Mailed FIT outreach has been demonstrated to reduce colorectal cancer incidence and mortality in a large integrated delivery system,” Gloria D. Coronado, an epidemiologist at the University of Arizona Cancer Center in Tucson, told Healio. “This study demonstrates that these programs can also be successfully delivered in rural settings. They may also address barriers to care access, which can be more prevalent in rural vs. urban communities.”