Introducing Neoadjuvant Immunotherapy for Colorectal Cancer: Advancing the Frontier

Area of Science:

• Oncology
• Immunotherapy
• Colorectal Cancer Research

Background:

• Immunotherapy has transformed cancer care but faces challenges in applicability and response heterogeneity.
• Factors influencing immunotherapy efficacy include patient characteristics, treatment timing, immune responses, tumor microenvironment, and genetic alterations.

Purpose of the Study:

• To review current and future applications of neoadjuvant immunotherapy in localized colorectal cancer (CRC).
• To discuss immunotherapy response prediction using biomarkers and radiologic assessments.
• To explore future clinical implications and challenges of neoadjuvant immunotherapy in CRC.

Main Methods:

• Narrative review of immunotherapy types for localized CRC.
• Discussion of predictive biomarkers and radiologic assessments for treatment response.
• Analysis of future perspectives, clinical implications, and response patterns.

Main Results:

• Neoadjuvant immunotherapy demonstrates potential in localized colorectal cancer.
• Mismatch repair (MMR) status is crucial for predicting response, especially in deficient MMR cases.
• Complete response rates are promising, suggesting potential for organ-sparing approaches.

Conclusions:

• Mismatch repair (MMR) status at diagnosis is key for neoadjuvant immunotherapy in localized CRC.
• Efficacy is most notable in patients with deficient MMR status and polymerase epsilon mutations.
• Neoadjuvant immunotherapy offers promising complete response rates, potentially enabling a watch-and-wait strategy for some patients.