Neoadjuvant immunotherapy in dMMR colon cancer: Dutch NICHE-2 trial reveals systemic survival breakthroughs—what global disparities and historical inequities in cancer care reveal about equitable precision medicine
Original framing: “[Articles] Disease-free survival and overall survival after neoadjuvant immunotherapy in mismatch repair-deficient colon cancer in the Netherlands: results of the single-arm, multicentre, phase 2, NICHE-2 trial” — The Lancet
The success of neoadjuvant immunotherapy in dMMR colon cancer must be contextualised within the historical trajectory of cancer research, which has been shaped by colonialism, eugenics, and systemic racism. The Tuskegee Syphilis Study (1932–1972) and the Willowbrook Hepatitis Study are stark examples of how marginalised populations have been exploited in medical research, leading to enduring distrust in clinical trials. The NICHE-2 trial’s homogeneity—limited to Dutch patients—mirrors the historical exclusion of non-Western and non-white populations from groundbreaking medical advancements. Furthermore, the development of immunotherapy itself is rooted in the military’s early experiments with cancer vaccines during World War II, which further entangles medical progress with state-driven eugenic ideologies. Without acknowledging these historical patterns, the trial’s results risk perpetuating the same inequities they aim to address.
The NICHE-2 trial’s 100% survival rate for dMMR colon cancer patients in the Netherlands represents a scientific milestone, yet its framing as a universal breakthrough obscures the systemic inequities that have historically excluded marginalised populations from medical progress.
The trial’s homogeneity—limited to Dutch patients—mirrors the colonial and eugenic legacies of cancer research, where Black, Indigenous, and low-income communities have been systematically marginalised, eroding trust and limiting participation. Cross-culturally, traditional medicine systems offer complementary pathways to immune modulation, yet these are rarely integrated into clinical guidelines, reinforcing biomedical dominance. The trickster’s gaze reveals the irony of a 'cure' that remains inaccessible to those most burdened by cancer, while future modelling must account for scalability challenges, including drug costs and resistance. To address these gaps, solutions must centre equity—through decentralised trials, integrative care models, cost-transparency initiatives, and historical reconciliation—ensuring that immunotherapy becomes a right, not a privilege. The path forward lies in co-creating solutions with marginalised communities, acknowledging their knowledge, and dismantling the power structures that have long perpetuated healthcare disparities.