Akhil Kapoor/X
Jul 9, 2025, 18:16
Akhil Kapoor: We Acknowledge and Appreciate the Trial’s Bold and Innovative Approach in Challenging Established Treatment Paradigms
Akhil Kapoor, Professor of Medical Oncology at Tata Memorial Centre, shared on LinkedIn:
“Pleased to share our recent correspondence in The Lancet Oncology that discusses key concerns related to the SANO trial.
While we raise critical points, we also acknowledge and appreciate the trial’s bold and innovative approach in challenging established treatment paradigms.
Issue 1 – Definition of cCR
- Lack of universally accepted and reproducible criteria
- Imaging and biopsy may miss microscopic disease
Issue 2 – Delayed Salvage Surgery
- Risk of worse outcomes due to tumor progression during surveillance
Issue 3 – Generalizability
- Highly specialized centers in Netherlands; may not be reproducible in routine practice, especially LMICs
Despite limitations, the SANO trial:
- Challenges dogma of ‘surgery for all’
- Promotes patient-centered, organ-preserving approaches
- Opens door for tailored therapy based on response
Title: SANO trial: innovations, risks, and unanswered questions
Authors: Akhil Kapoor, Bal Krishna Mishra, Vanita Noronha, Kumar Prabhash
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