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Nimmi Ramanujam
Nimmi Ramanujam says waiting until after surgery to begin immunotherapy limits the immune system’s information. Photo by Chris Hildreth

BREAST CANCER

Could it be treated before surgery?
Story by Scott Huler
Dec 01, 2025

Nimmi Ramanujam looks at big-picture stuff. Not just “How does this cell work?” but, say, “How do we improve women’s lives and health?” She founded the Center for Global Women’s Health Technologies in 2013 to improve the treatment of cervical cancer and breast cancer for women all over the world.

“It’s not one technology that solves a problem,” says Ramanujam, Robert W. Carr Jr. Distinguished Professor of Biomedical Engineering, “but a systems-thinking approach, where technologies and the clinical paradigm synergize to change the way that care is delivered.”

This approach has led to a new technology and care paradigm for breast cancer that could improve not just women’s outcomes but their ability to easily and inexpensively get treatment. It’s so promising that she received a $10.4 million 2024 Innovator Award from the Department of Defense Breast Cancer Research Program.

The new treatment would use a kind of immunotherapy that would, unlike current immunotherapies, start before tumor removal, not after. In fact, it would be injected soon after a woman was diagnosed with breast cancer. 

“Most times immunotherapy is given after surgery,” Ramanujam says. “We’re saying it should be given before. You need to have the tumor to send signals to the immune system that this is what you need to kill or attack.” So waiting until after surgery to begin immunotherapy limits the immune system’s information. 

On the other hand, much current immunotherapy is toxic, so it is limited only to certain populations. Starting earlier, injecting women with a simpler and less-toxic agent that helps prime the immune system, may mean that it could be used more widely. One action of the new agent – an injectable polymer called ethyl cellulose, dissolved in ethanol – is to be destructive to tumor cells. The other action will be to disrupt the way the tumor prepares its environment to attack malevolent cells.

The hope is that by the time the tumor is removed surgically, the immune response will continue to be improved enough to possibly not require further treatments. This makes the treatment not only less invasive but more effective for women for whom visiting a hospital is a challenge.

“If successful,” Ramanujam says, “it would basically allow clinical care to be completed at the time of surgery.” 

The treatment has been effective in animal trials. “We’re very excited,” Ramanujam says, “because we’re well on our way to get approvals to start patient studies in 2026.”

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