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By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! Welcome to a special ASCO edition of Health Rounds featuring potentially practice- and procedure-changing studies presented at the American Society of Clinical Oncology scientific meeting underway through June 6 in Chicago.

See also the following breaking news from ASCO on Reuters.com: Cancer vaccines poised to unlock new treatment paradigm with Merck/Moderna data; Cancer drugmakers’ shares surged with reports of positive trial data; AstraZeneca drug slashes death risk in post-surgery lung cancer patients; Novartis drug cuts recurrence risk by 25% in early-stage breast cancer; and Servier’s brain cancer drug slows tumor progression considerably.

Keep up with additional news from the conference with hashtag #ASCO23 on social media.

Patients with triple-negative breast cancer who are initially ineligible for life-extending treatment with Enhertu may become eligible later as their disease progresses, research shows. AstraZeneca/Handout via REUTERS

New drugs and modern technology are enabling patients to undergo less extensive surgeries in several situations, potentially enhancing post-procedure quality of life, as demonstrated in these studies reported at the year’s most important cancer meeting.

In an international study involving 500 patients with low-risk early cervical cancer, removing only the uterus and cervix was just as effective as removing the uterus, cervix, upper vagina, and other tissues, researchers reported on Friday at ASCO. Three years later, patients who had undergone the less extensive operation had an equally good survival rate but fewer surgical complications and better quality of life, the researchers reported.

Separately, in 258 patients with pancreas cancer, success in removing all of the cancer, and cancer recurrence rates in nearby tissues, were similar whether patients had minimally invasive surgery or open surgery with large incisions, the international research team reported on Monday at the meeting. Minimally invasive surgery generally means faster recovery from the procedure and fewer potential complications.

Also on Monday, South Korean researchers reported on a study of 580 patients with early gastric cancer that found stomach removal is not always necessary. If there was no sign of cancer in the nearest lymph nodes, the stomach could be left in place, the researchers said. Disease-free survival rates at three years were just as good in those cases, but patients’ quality of life was much better than those whose stomachs were surgically removed, they said.

And in a preliminary trial in 50 patients with squamous cell skin cancers who were scheduled for disfiguring operations, pre-treatment with immunotherapy drugs sometimes made surgery unnecessary, researchers from The Netherlands reported on Monday. Prior to surgery, the patients received either one or both of Bristol Myers Squibb’s immunotherapies – Opdivo (nivolumab) or Opdivo plus Yervoy (ipilimumab). Most saw their tumors shrink significantly, but still required surgery. Nine patients, however, no longer required surgery and remain cancer-free a year later, on average.

These nine patients have proven the concept that organ preservation and durable complete remissions can be achieved with immunotherapy “without extensive or mutilating curative surgery and/or radiation therapy,” the researchers said.

Patients with the most aggressive form of breast cancer who are initially ineligible for treatment with a powerful new drug may become candidates for the life-extending medicine as their disease progresses, new research has found.

Enhertu (fam-trastuzumab deruxtecan-nxki) from Daiichi Sankyo and AstraZeneca has led to significant improvements in survival for patients with advanced triple-negative breast cancer. But only about half of them are eligible to use it – those whose cancer cell surfaces have at least low levels of a protein called HER2. Patients with metastatic triple negative breast cancer that is not classified as “HER2-low” do not benefit from the treatment, earlier studies have shown.

In 512 patients with triple-negative breast cancer, tumors that were initially HER2-negative were frequently HER2-low on subsequent biopsies obtained as the disease progressed, researchers reported on Monday at ASCO.

“We found that with repeat biopsies, we can identify new potential candidates for Enhertu, and in each successive biopsy, HER2-low is detected for one-third of the patients without a prior HER2-low result,” said study leader Dr. Yael Bar of the Breast Cancer Program at Mass General Cancer Center in Boston.

“Therefore,” she added, “we recommend considering repeat biopsies… to ensure that potential candidates with metastatic triple-negative breast cancer are not deprived of this important life-prolonging medication.”

Read more about Enhertu eligibility on Reuters.com

• Patient selection for AstraZeneca, Daiichi breast cancer drug needs improvement, experts say

When colon cancer has spread to nearby tissues by the time it is diagnosed, treatment with chemotherapy before surgery may be worth considering, researchers said on Sunday.

Doctors in three countries randomly assigned nearly 150 patients with locally advanced colon cancer to receive neoadjuvant, or pre-surgery, chemotherapy, or proceed directly to surgery.

Patients in the chemo group had fewer surgical complications and got out of the hospital faster, the researchers reported. In addition, fewer pre-treated patients needed the postoperative chemotherapy that usually follows these operations. Those who did, required fewer chemo infusions compared to patients who had surgery first, the researchers found.

Two years later, survival rates were similar in the two groups, they said.

Patients now have a real choice between the traditional upfront surgery and neoadjuvant chemotherapy,” study leader Dr. Lars Henrik Jensen of the University Hospital of Southern Denmark in Vejle said in a statement. “Effect and safety is at least as favorable, and patient preference can be included in the individual treatment plan.”

This newsletter was edited by Bill Berkrot.

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