[Neoadjuvant immunotherapy for colorectal cancer]

Area of Science:

• Oncology
• Immunology
• Gastroenterology

Context:

• Colorectal cancer (CRC) treatment landscape is evolving with immunotherapy.
• Microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) tumors show significant response to immunotherapy.
• Neoadjuvant immunotherapy is being explored for its potential benefits in CRC.

Purpose:

• To review the current research progress, controversies, and challenges of neoadjuvant immunotherapy in colorectal cancer.
• To highlight the efficacy and potential of neoadjuvant immunotherapy in MSI-H/dMMR CRC patients.
• To discuss future research directions for optimizing neoadjuvant immunotherapy in both MSI-H/dMMR and MSS/pMMR CRC.

Summary:

• Neoadjuvant immunotherapy demonstrates a near 100% response rate in MSI-H/dMMR colorectal cancer, with pathological complete response rates of 60-67%.
• The goal is to achieve sustainable clinical complete responses, facilitating organ preservation and minimizing treatment-related functional deficits.
• For microsatellite stable (MSS) or mismatch repair proficient (pMMR) CRC, combination therapies and biomarker identification are key research areas.

Impact:

• Neoadjuvant immunotherapy holds promise for improving outcomes and quality of life in specific colorectal cancer patient populations.
• Addressing challenges like resistance and accurately identifying treatment responses (pseudoprogression/hyperprogression) is crucial for clinical application.
• Further research into optimizing regimens and predictive biomarkers will expand the utility of immunotherapy in colorectal cancer.