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Preliminary study on BRICS sequential therapeutic regimen as salvage treatment for refractory advanced colorectal
Yonghai Peng1, Jian Wang2, Junhui Wang3
1Department of Oncology, Cangshan Hospital Area, 900 Hospital of the Joint Logistics Support Force, Fujian, Fuzhou, China.
Background:
Patients with refractory mismatch repair-proficient/microsatellite stable (pMMR/MSS) metastatic colorectal cancer exhibit intrinsic resistance to immune checkpoint inhibitors and conventional salvage therapies, with median overall survival (OS) is typically less than 10 months. This study evaluates the novel BRICS sequential regimen (Bifidobacterium supplementation, Radiotherapy, Immunotherapy, Chemotherapy, Stereotactic approach) in this population.
Methods:
In this retrospective analysis, 27 refractory pMMR/MSS metastatic CRC patients received BRICS: Stereotactic body radiotherapy to a single lesion, indefinite high-dose probiotics, followed by low-dose chemotherapy plus PD-1 inhibitor. Primary endpoints were objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and OS.
Results:
Efficacy outcomes: ORR 33.3% (9 partial responses), DCR 88.9%, median PFS 7.20 months (95% CI: 5.23-9.18), and median OS 12.30 months (95% CI: 9.89-14.71). Eastern Cooperative Oncology Group Performance Status (ECOG PS) >2 independently predicted inferior OS (HR = 4.860; p=0.042), while metastatic burden (≥3 organs) predicted shorter PFS (HR = 3.179; p=0.026). Grade 3-4 adverse events occurred in 22.2% of patients (neutropenia: 14.8%; thrombocytopenia: 3.7%; anemia: 3.7%).
Conclusions:
BRICS demonstrates clinically meaningful efficacy (DCR 88.9%, mOS 12.3 months) and manageable toxicity in refractory pMMR/MSS metastatic CRC. ECOG PS >2 and high metastatic burden identify patients with limited benefit, warranting prospective validation in biomarker-enriched cohorts.
Insights
The novel BRICS regimen shows promise for refractory mismatch repair-proficient/microsatellite stable metastatic colorectal cancer, improving outcomes with an 88.9% disease control rate and 12.3-month median overall survival. This approach offers a new treatment option for patients resistant to standard therapies.
Area of Science:
- Oncology
- Immunotherapy
- Gastroenterology
Background:
- Metastatic colorectal cancer (CRC) that is mismatch repair-proficient/microsatellite stable (pMMR/MSS) is resistant to current treatments.
- Patients with refractory pMMR/MSS CRC have a poor prognosis, with median overall survival (OS) under 10 months.
Purpose of the Study:
- To evaluate the efficacy and safety of the novel BRICS sequential regimen in patients with refractory pMMR/MSS metastatic CRC.
- To assess objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and OS.
Main Methods:
- A retrospective analysis of 27 patients with refractory pMMR/MSS metastatic CRC treated with the BRICS regimen.
- BRICS includes Stereotactic body radiotherapy, high-dose probiotics, low-dose chemotherapy, and PD-1 inhibitor therapy.
Main Results:
- The BRICS regimen achieved an ORR of 33.3% and a DCR of 88.9%.
- Median PFS was 7.20 months and median OS was 12.30 months.
- Eastern Cooperative Oncology Group Performance Status (ECOG PS) >2 and metastatic burden (≥3 organs) were associated with poorer outcomes. Grade 3-4 adverse events occurred in 22.2% of patients.
Conclusions:
- The BRICS regimen demonstrates clinically meaningful efficacy and manageable toxicity in refractory pMMR/MSS metastatic CRC.
- ECOG PS >2 and high metastatic burden predict limited benefit, suggesting the need for prospective validation in biomarker-selected populations.
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