Perioperative Immunotherapy in Breast and Gastrointestinal Cancers: From Immune Response to Clinical Outcomes

Perioperative immunotherapy — administered before surgery, within the perioperative window, or after resection — is rapidly becoming a treatment paradigm across multiple solid tumours, with breast cancer and gastrointestinal cancers at the forefront of this evolution. Neoadjuvant approaches can induce early systemic immune activation, reduce micrometastatic disease, and generate measurable pathologic response while the primary tumour is in situ. However, international adoption remains heterogeneous because critical questions span surgical oncology, medical oncology, pathology, radiology, and perioperative medicine. These include optimal surgical timing after immunotherapy, reliable response assessment across imaging and pathology, and safe perioperative management without compromising curative intent.In addition, perioperative treatment introduces unique biological and clinical complexities, including immune priming within the tumour and draining lymph nodes, minimal residual disease dynamics, and immune perturbations associated with surgical stress and wound healing. With trials expanding globally, harmonized endpoints, standardized workflows, and implementable clinical pathways are urgently needed to translate promising signals into reproducible real-world benefit.This Research Topic will bring together international multidisciplinary teams to define best practices and research priorities for perioperative immunotherapy in solid tumours, with particular emphasis on breast cancer and gastrointestinal cancers. We aim to accelerate clinical translation by focusing on:- Trial designs that are feasible across diverse health systems in different countries- Pathologic response assessment integrating pathology, imaging, and biomarkers- Perioperative safety frameworks that capture both surgical and immune-related toxicitiesA central objective is to move from proof-of-concept to implementation: when to operate, how to sequence therapies, when to hold or resume immunotherapy, and how to coordinate imaging, pathology, postoperative care and postoperative surveillance.Contributions that bridge high-volume academic experience with pragmatic real-world implementation — aligned with our team’s outcomes-oriented surgical oncology perspective — are especially encouraged.We welcome work that addresses global variation in tumour epidemiology, access to therapeutics and imaging, pathology infrastructure, and follow-up intensity. By comparing approaches across regions and health systems, this collection aims to support reproducible science and practical guidance that can be adopted worldwide.While contributions across solid tumours are welcome, we particularly encourage submissions focused on breast cancer and gastrointestinal cancers (including gastric, colorectal, oesophageal, hepatobiliary, and pancreatic malignancies). We welcome Original Research, Review, Mini Review, and Perspective articles addressing, but not limited to:- Trial design and endpoints: standardized pCR/MPR definitions, specimen handling and reporting checklists, surrogate endpoints (EFS/DFS/OS), pragmatic and adaptive trial designs, and optimal timing of surgery following immunotherapy (including treatment delays and bridging strategies).- Biomarker strategies with clinical utility: ctDNA for response and relapse risk, tissue immune profiling, radiologic–pathologic correlation, longitudinal sampling across resource-variable settings, and decision frameworks for postoperative escalation or de-escalation.- Surgical outcomes and perioperative safety: standardized reporting of complications, wound healing and reconstructive considerations, perioperative steroid and immunosuppression management, immune-related adverse events in the perioperative period, and care pathways that reduce cancellations, readmissions, and morbidity.- Patient selection and multidisciplinary pathways: resectability and borderline resectable disease, MDT decision-making models, coordination across referral networks, and implementation science addressing global access, equity, and real-world feasibility.Please note: manuscripts based solely on bioinformatics or computational analysis of public databases without independent validation (e.g., external clinical cohort or biological validation in vitro or in vivo) are out of scope and will not be considered as part of this Research Topic. Topic editors: Marissa Boyle, Wenxue Ma, Prof Dr Martin Gasser, Zhongren David Zhou, Francesco Giovinazzo Source: https://www.frontiersin.org/research-topics/78248/perioperative-immunotherapy-in-breast-and-gastrointestinal-cancers-from-immune-response-to-clinical-outcomes