Neoadjuvant Immunotherapy Alone for Patients With Locally Advanced and Resectable Metastatic Colorectal Cancer of dMMR/MSI-H Status.

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yingjie Li,Luxin Tan,Nan Chen,Xinzhi Liu,Fei Liang,Yunfeng Yao,Xiaoyan Zhang,Aiwen Wu
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引用次数: 0

Abstract

BACKGROUND The use of programmed death-1 blockade has a significant therapeutic effect in patients with Mismatch Repair-Deficient/Microsatellite Instability-High metastatic colorectal cancer. However, data on preoperative single-agent programmed death-1 blockade are rare. OBJECTIVE This study aims to evaluate the effectiveness and safety of preoperative programmed death-1 blockade as a conversion strategy in patients with locally advanced and resectable metastatic Mismatch Repair-Deficient/Microsatellite Instability-High colorectal cancer. DESIGN This is a retrospective observational study. SETTINGS This study was conducted at a high-volume tertiary referral cancer center in China. PATIENTS Twenty-four patients of consecutive cases since 2020-2022 with Mismatch Repair-Deficient/Microsatellite Instability-High colorectal cancer who received preoperative single-agent programmed death-1 blockade were retrospectively reviewed. These patients had either bulking tumor scheduled for multivisceral resection, a strong desire for organ preservation, or potentially resectable metastatic lesions. MAIN OUTCOME MEASURES Pathological complete response, clinical complete response, toxicity, R0 resection rate, and complications were evaluated. RESULTS Patients tolerated preoperative immunotherapy well. The R0 resection rate was 95.2% and the pathological complete response rate was 47.6%. Three patients (12.5%) were evaluated as clinical complete response and then underwent "watch and wait". One half of the cT4b patients were spared multivisceral resection, while 60% (3/5) achieved pathological complete response. All three patients with liver metastases obtained CR of all liver lesions after programmed death-1 blockade treatment. Grade III postoperative complications occurred in two patients. LIMITATIONS The limitations of this study are as follows: retrospective study, small sample size, and short follow-up. CONCLUSIONS Preoperative anti-programmed death-1 therapy alone as a conversion strategy in initially resected difficult dMMR/MSI-H colorectal cancer can achieve a high tumor complete response. The use of immuno-preoperative therapy in patients with T4b colon cancer or low rectal cancer can reduce multivisceral resection and achieve high organ function preservation. See Video Abstract.
对 dMMR/MSI-H 状态的局部晚期和可切除转移性结直肠癌患者单独采用新辅助免疫疗法。
背景在错配修复缺陷/微卫星不稳定性高的转移性结直肠癌患者中使用程序性死亡-1阻断剂具有显著的治疗效果。本研究旨在评估将术前程序性死亡-1阻断作为转换策略用于局部晚期和可切除转移性错配修复缺陷/微卫星不稳定性高的结直肠癌患者的有效性和安全性。设计这是一项回顾性观察研究。设置本研究在中国一家高容量三级癌症转诊中心进行。患者回顾性回顾了2020-2022年以来连续接受术前单药程序性死亡-1阻断治疗的24例错配修复缺陷/微卫星不稳定性高的结直肠癌患者。对这些患者的病理完全反应、临床完全反应、毒性、R0切除率和并发症进行了评估。结果患者对术前免疫疗法的耐受性良好。R0切除率为95.2%,病理完全反应率为47.6%。3名患者(12.5%)被评估为临床完全反应,然后进行了 "观察和等待"。一半的 cT4b 患者免于多脏器切除,60%(3/5)的患者获得了病理完全反应。3名肝脏转移患者在接受了程序性死亡-1阻断治疗后,所有肝脏病变均获得了CR。局限性本研究的局限性如下:回顾性研究、样本量小、随访时间短。结论对于初步切除的困难dMMR/MSI-H结直肠癌,术前单独使用抗程序性死亡-1疗法作为转换策略可获得较高的肿瘤完全反应。在T4b结肠癌或低位直肠癌患者中使用免疫术前疗法可减少多脏器切除,实现高器官功能保留。参见视频摘要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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