Researchers behind the Optima trial found that a genomic test called Prosigna can identify patients who are unlikely to benefit from chemotherapy after surgery. For many of these patients, hormone therapy alone produced similar outcomes.

The findings could help doctors personalize treatment decisions and reduce unnecessary exposure to chemotherapy and its side effects.

How the Study Was Conducted

The Optima trial enrolled 4,429 patients aged 40 and older with hormone receptor-positive breast cancer. This is the most common type of breast cancer worldwide.

Doctors typically recommend chemotherapy for patients in this group because they face a higher risk of recurrence. Researchers from institutions including University College London and the University of Glasgow used genomic testing to determine whether some patients could safely avoid the treatment.

The study focused on the Prosigna test, which examines the activity of 50 genes within a tumor. The test estimates the likelihood that cancer will return within 10 years and helps identify patients who may benefit most from chemotherapy.

Similar Outcomes Without Chemotherapy

Researchers reported that patients classified as lower risk achieved similar results whether they received chemotherapy or not.

Five years after treatment, 93.7% of patients who received hormone therapy without chemotherapy remained alive and free from breast cancer recurrence. Among those who underwent both chemotherapy and hormone therapy, the figure was 94.9%.

The researchers concluded that omitting chemotherapy did not significantly worsen outcomes for patients identified as lower risk through genomic testing.

Reducing Treatment Burden

Chemotherapy remains an important treatment for many breast cancer patients. However, it can cause significant side effects, including fatigue, nausea, hair loss, fertility complications and cognitive difficulties.

As a result, researchers have increasingly explored ways to identify patients who can safely avoid the treatment.

The Optima investigators estimated that more than two-thirds of patients in the study could potentially skip chemotherapy when doctors used genomic testing to guide treatment decisions.

The findings support the growing use of precision oncology, an approach that tailors treatment based on the biological characteristics of an individual’s tumor rather than relying solely on traditional risk factors.

Part of a Broader Shift in Breast Cancer Care

The results add to a growing body of evidence supporting genomic testing in breast cancer treatment.

Earlier studies involving genomic tools such as Oncotype DX also found that many patients with hormone receptor-positive, HER2-negative breast cancer can safely forgo chemotherapy when genetic testing indicates a low likelihood of benefit.

However, treatment recommendations still depend on several factors, including age, menopausal status, lymph node involvement and specific tumor characteristics.

Researchers stressed that the Prosigna test is not intended to replace chemotherapy altogether. Instead, it helps identify patients who are less likely to benefit from the treatment.

Potential Impact on Future Care

The Optima trial could influence future breast cancer treatment guidelines and help reduce unnecessary chemotherapy use.

Beyond improving patient quality of life, a more targeted treatment approach could lower healthcare costs by avoiding therapies that provide limited benefit.

Researchers said they will continue monitoring trial participants to assess long-term outcomes and confirm the durability of the findings.

The results highlight the increasing role of genomic medicine in cancer care and suggest that many patients may be able to receive effective treatment with fewer side effects.

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Breakthrough in Early Cancer Detection

The Galleri blood test, developed by U.S.-based pharmaceutical company Grail, can detect fragments of cancerous DNA circulating in the bloodstream. It is designed to identify cancers at an early stage, when treatment is more likely to be effective and potentially curative.

In a trial involving 25,000 adults in the United States and Canada over one year, nearly 1% of participants received a positive test result. Subsequent medical follow-up confirmed cancer in 62% of these cases. Lead researcher Dr. Nima Nabavizadeh, associate professor of radiation medicine at Oregon Health & Science University, stated that the findings could “fundamentally change” the approach to cancer screening.

High Accuracy and Early Detection

The trial demonstrated that the Galleri test correctly ruled out cancer in over 99% of participants who tested negative. More than half of detected cancers were identified at an early stage, increasing the likelihood of successful treatment.

When combined with conventional screening for breast, bowel, lung, and cervical cancers, the test increased the total number of detected cancers seven-fold. Notably, three-quarters of detected cases were cancers for which no routine screening currently exists, including ovarian, liver, stomach, bladder, and pancreatic cancers.

The test accurately identified the origin of cancer in approximately 90% of cases, providing crucial information for timely and targeted treatment.

Expert Perspectives on Potential Impact

Sir Harpal Kumar, president of biopharma at Grail, described the results as “very compelling,” emphasizing that most cancer deaths occur because cancers are detected too late. “The goal is to shift to earlier detection, when we can use treatments that are more effective and potentially curative,” he said on BBC Radio 4.

However, some experts caution that earlier detection does not automatically translate into reduced mortality. Clare Turnbull, professor of translational cancer genetics at The Institute of Cancer Research in London, stressed the need for randomized studies with mortality as a primary endpoint to confirm the test’s real-world benefits.

Naser Turabi of Cancer Research UK added that careful evaluation is required to avoid overdiagnosis of cancers that may never have caused harm. He noted that the UK National Screening Committee will play a central role in reviewing evidence before any NHS adoption.

Ongoing Research and NHS Trials

The topline results from the North American trial are set to be presented at the European Society for Medical Oncology congress in Berlin, though full peer-reviewed data have not yet been published.

In England, a three-year NHS study involving 140,000 participants is underway, with results expected next year. The NHS has indicated that, if the findings are favorable, the Galleri test could be expanded to an additional one million people, potentially reshaping national cancer screening strategies.

Future Implications for Cancer Care

The Galleri test represents a potential leap forward in early cancer detection, particularly for cancers lacking established screening programs. Experts highlight its promise in identifying diseases when interventions are most effective, potentially reducing the burden of late-stage diagnoses.

At the same time, further research is essential to understand the balance between early detection and overdiagnosis. Ongoing trials and rigorous peer-reviewed studies will be critical in determining how the test may be integrated into routine clinical practice.

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Source: BBC – Exciting results from blood test for 50 cancers

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Lung cancer is often linked in our minds with smoking — but what happens when people who have never smoked start getting diagnosed more and more? The surprising rise of lung cancer among non-smokers is turning heads in the medical world, challenging old assumptions and raising important questions about causes, risks, and treatment.

Martha’s Story: A Wake-Up Call

Take Martha’s experience. At 59, she never considered herself a smoker — sure, she’d occasionally lit a cigarette at parties, but nothing regular. So when her cough changed and her mucus thickened, she thought it was just a flare-up from a rare lung disorder she already had. Doctors initially agreed it was nothing to worry about.

But after an X-ray revealed a shadow on her lung, things quickly escalated. A CT scan and bronchoscopy confirmed a tumour. Four months after she first mentioned symptoms, Martha was diagnosed with Stage IIIA lung cancer. The tumour had invaded nearby lymph nodes but hadn’t spread further.

“It was a total shock,” Martha says. And her story isn’t unique.

Lung Cancer Beyond Smoking: A Growing Global Concern

Lung cancer remains the world’s most common cancer and the deadliest, with around 2.5 million new cases and 1.8 million deaths in 2022 alone. While smoking still accounts for the majority of cases, smoking rates have dropped in many parts of the world over the last decades. At the same time, lung cancer diagnoses among people who have never smoked now make up 10 to 20% of cases — and that percentage is rising.

Dr. Andreas Wicki, an oncologist from the University Hospital Zurich, explains, “Lung cancer in never-smokers is emerging as a distinct disease, with unique molecular features that affect treatment and outcomes.” Interestingly, younger lung cancer patients—those in their 30s or 40s—are more likely to be non-smokers, and the cancer type tends to differ as well.

A Different Type of Lung Cancer

The kind of lung cancer common among smokers—squamous cell carcinoma—used to dominate until the mid-20th century. But in never-smokers, nearly all lung cancers are adenocarcinomas, which originate in mucus-producing cells.

The catch? Adenocarcinomas are often diagnosed late because small tumors don’t cause obvious symptoms. Persistent cough, chest pain, and breathlessness only show up once the tumour grows or spreads. “Because most people associate lung cancer with smoking, non-smokers may dismiss early warning signs, delaying diagnosis until advanced stages,” says Wicki.

Why Are Women More Affected?

Non-smoking women are more than twice as likely as men who never smoked to develop lung cancer. This may be linked to differences in lung anatomy, environmental exposures, and genetics. A key player is a mutation called EGFR, which is especially common in women and notably in Asian women.

Scientists suspect female hormones and genetic variants affecting estrogen metabolism might explain this higher incidence, though research is ongoing.

The Role of Genetics: Driver Mutations and Targeted Therapies

Cancer cells in non-smokers often carry “driver mutations” that fuel tumour growth. EGFR mutations are the best-known example. Once these mutations were identified, drug companies developed targeted therapies—EGFR inhibitors—that block the mutant protein’s activity.

“About 20 years ago, these drugs showed great promise,” Wicki says. “Many patients responded well, but resistance often developed, leading to relapse.” Newer generations of these drugs are now improving survival, with some patients living more than 10 years after diagnosis—an incredible leap from the less-than-12-month survival rates seen two decades ago.

What’s Causing Lung Cancer in Non-Smokers?

Without smoking as a cause, what else is driving lung cancer? Experts point to a mix of environmental and genetic factors:

• Radon exposure and second-hand smoke
• Indoor air pollution from cooking fumes and burning wood or coal, especially in poorly ventilated homes
• Outdoor air pollution, which is now recognized as the second leading cause of lung cancer worldwide after smoking

Air pollution—specifically tiny particles called PM2.5 found in vehicle exhaust and fossil fuel smoke—has been linked to lung cancer, particularly among those with EGFR mutations.

How Air Pollution May Trigger Lung Cancer

New research from the Francis Crick Institute in London sheds light on how air pollution might kickstart lung cancer in non-smokers carrying the EGFR mutation. Instead of directly mutating DNA like cigarette smoke, PM2.5 particles activate immune cells called macrophages. These cells release signals that “wake up” dormant mutant cells in the lungs, pushing them to grow into tumors.

This discovery opens exciting possibilities for new ways to prevent lung cancer by targeting the lung environment, not just the cancer cells themselves.

The Bigger Picture: Air Pollution’s Growing Impact

Air pollution’s connection to lung cancer isn’t new—it was mentioned as a possible cause as early as 1950. Yet for decades, anti-smoking policies dominated lung cancer prevention.

Today, 99% of the world’s population lives in areas exceeding the World Health Organization’s air quality guidelines. Rising pollution in places like India and China means the lung cancer burden from environmental factors may grow.

In the US, wildfires are causing spikes in PM2.5 levels, linked to increased lung cancer cases. Experts agree that shifting away from fossil fuels is critical not only for climate change but also for lung health.

Looking Ahead: Changing Perceptions and Hope

As treatments improve, lung cancer in never-smokers is becoming more manageable, challenging the stereotype that lung cancer is a smoker’s disease or a death sentence.

Martha, now almost three years post-diagnosis, takes an EGFR inhibitor. It’s not easy—side effects like fatigue and skin issues make daily life challenging—but the drug works. “The fatalistic view of lung cancer is changing, and that’s a hopeful sign,” she says.

With ongoing research and growing awareness of environmental risks, the future may hold better prevention and longer survival for those diagnosed with this mysterious form of lung cancer.

Source: BBC – The mystery rise of lung cancer in non-smokers

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Kelly Spill’s life changed in an instant when she was diagnosed with stage III rectal cancer at just 28 years old. But it wasn’t the diagnosis itself that brought her to tears. It was the thought of having her life upended forever—potentially losing the ability to have more children and facing the need for a colostomy bag after surgery.

The emotional breaking point came when she asked her doctor about a planned elopement to Switzerland with her fiancé, only to be told, “Oh, absolutely not.” That moment made her realize that everything she envisioned for the future was now uncertain.

Fast forward five years, and Kelly is not only cancer-free but also expecting her third child. This incredible turn of events is thanks to a groundbreaking cancer treatment: immunotherapy.

Immunotherapy Changes Lives

Kelly’s journey took a positive turn when she was offered a chance to join a clinical trial using the immunotherapy drug dostarlimab, developed by GSK and marketed under the name Jemperli. This treatment, which harnesses the body’s own immune system to target and eliminate cancer cells, helped Kelly avoid the aggressive chemotherapy, radiation, and surgery that were initially recommended.

Dostarlimab has already shown promise in earlier research, even earning designation as a “breakthrough therapy” by the FDA for treating certain rectal cancers. But a new study, published in The New England Journal of Medicine, reveals the drug’s potential to treat various cancer types effectively, allowing patients to bypass surgery and avoid more invasive treatments.

Kelly’s experience is a testament to this innovation. After just nine treatments, her tumor had completely disappeared. “I was told I didn’t need surgery or radiation, and that was the best day of my life,” she says. “It felt like a miracle.”

A Life-Changing Treatment for Many

The study included 117 patients with different types of solid tumors, including rectal, colon, gastric, bladder, and prostate cancers. The key factor was that these patients had mismatch repair-deficient (dMMR) tumors, which are more likely to respond to immune-based treatments.

Dr. William Dahut, chief scientific officer at the American Cancer Society, explains the science behind it: “With DNA repair deficiencies, patients often have more mutations, which makes their tumors more vulnerable to immunotherapy.”

This study found that 80% of participants treated with dostarlimab saw their tumors vanish without needing surgery, chemotherapy, or radiation. Even more remarkable, these patients were able to lead normal lives, with their organs intact. Some women even went on to conceive and give birth—something that would not have been possible with traditional treatments.

The Future of Cancer Treatment

While the results of this trial are groundbreaking, researchers caution that larger studies are necessary to confirm the long-term benefits, especially for patients with non-rectal cancers. However, the findings mark a significant shift in cancer care, moving away from invasive surgeries and toxic treatments.

Dr. Andrea Cercek, a gastrointestinal oncologist, calls it a “game-changer” for patients. “We can eliminate cancer with minimal side effects, leaving patients feeling well and living normal lives,” she says.

This marks a new era of cancer treatment, where immunotherapy is not just an option but potentially the future. As Dr. Stacey Cohen from Fred Hutchinson Cancer Center points out, the era of non-operative cancer care could soon become the new standard, offering hope for patients with cancers previously deemed too difficult to treat without surgery.

A Call for Early Detection

For Kelly Spill, the decision to join a clinical trial was life-altering. But her experience also highlights a critical issue: early detection of colorectal cancer in younger adults. The American Cancer Society reports a troubling rise in colorectal cancer cases among people under 55, with the proportion increasing from 11% in 1995 to 20% in 2019.

Kelly urges others to trust their instincts and advocate for themselves. “Don’t wait. If something doesn’t feel right, push for answers,” she says. She recalls the moment when blood in her stool led to her diagnosis, emphasizing the importance of being proactive, especially for young adults who may overlook symptoms.

Looking Ahead

As immunotherapy continues to evolve, researchers are optimistic about its potential to treat a wide range of cancers, not just rectal cancer. While not all patients respond equally to the treatment, its promise in reducing the need for surgery and improving quality of life is undeniable.

For Kelly, the journey from cancer diagnosis to pregnancy and remission has been nothing short of extraordinary. “Take a deep breath and trust the timing,” she advises, reflecting on the hurdles she’s overcome. “You never know what treatment might change your life.”

This groundbreaking study offers hope to many, with the possibility of a future where cancer is treated with less invasive methods and more effective results, changing the landscape of cancer care for the better.

Source: CNN – Immunotherapy helps certain cancer patients avoid surgery: ‘We hope this is the future’

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