A new clinical trial has found that giving the immunotherapy drug pembrolizumab before surgery instead of chemotherapy can help improve outcomes for people with stage two or three MMR deficient/MSI-High colorectal cancer. This study looked at 32 participants with MMR deficient/MSI-High colorectal cancer, finding that more than 50% of those treated with pembrolizumab before surgery had no signs of cancer after their surgery, compared to only 4% of those treated with chemotherapy. This approach aims to potentially cure the cancer upfront and eliminate the risk of future relapse, providing a promising new treatment option for these patients.
Colorectal cancer, also known as colon cancer or bowel cancer, is a significant global health issue with more than 1.9 million cases diagnosed in 2020 and a projected increase to 3.2 million cases by 2040. Some people with colorectal cancer may have tumors with high microsatellite instability due to a genetic mutation that affects mismatch repair (MMR) processes. Past research has shown that treating MMR deficient/MSI-High colorectal cancer tumors can be challenging, but immunotherapy with pembrolizumab has shown promise in improving outcomes for these patients. This new approach could potentially lead to higher rates of remission and long-term survival for individuals with stage two or three MMR deficient/MSI-High colorectal cancer.
The NEOPRISM-CRC phase II clinical trial focused on pembrolizumab, an immunotherapy drug that has been approved for MSI-H or dMMR colorectal cancer. Pembrolizumab works by stimulating the patient’s immune system to recognize and eliminate cancer cells. By giving pembrolizumab before surgery, researchers hope to shrink the cancer significantly or even eliminate it completely, potentially curing the cancer upfront and reducing the risk of relapse. This new treatment approach could offer a more effective and targeted option for individuals with MMR deficient/MSI-High colorectal cancer.
The results of the study showed that immunotherapy with pembrolizumab before surgery led to a significantly higher rate of patients having no signs of cancer after their surgery compared to traditional chemotherapy treatments. This novel approach could change the standard of care for stage two or three MMR deficient/MSI-High colorectal cancer patients by providing a more effective and less toxic treatment option. Further research is needed to confirm these findings and explore the long-term outcomes of this treatment approach, but the results so far are promising and could have a significant impact on the future treatment of colorectal cancer.
Anton Bilchik, MD, PhD, and Glenn S. Parker, MD, FACS, FASCRS, both shared their thoughts on the study, with Dr. Bilchik noting the novelty and potential of immunotherapy as a pre-surgery treatment for early-stage colon cancer, and Dr. Parker emphasizing the need for long-term follow-up to assess the duration of response. Both experts highlighted the importance of ongoing clinical trials to explore the role of immunotherapy and precision medicine in treating colorectal cancer. These findings suggest that immunotherapy could play a significant role in the future treatment of colorectal cancer, offering new hope and improved outcomes for individuals with MMR deficient/MSI-High tumors.
