Challenges of neoadjuvant immunotherapy in mismatch repair-deficient/microsatellite-unstable localized colon cancer...

Area of Science:

• Oncology
• Immunotherapy
• Gastrointestinal Oncology

Background:

• Mismatch repair-deficient (dMMR) colon cancer (CC) has shown efficacy with neoadjuvant immunotherapy.
• Clinical practice guidelines for neoadjuvant immunotherapy in dMMR CC are still evolving.
• Immune checkpoint inhibitors (ICIs) represent a key therapeutic strategy.

Purpose of the Study:

• To review key clinical trials on neoadjuvant/adjuvant ICIs in dMMR non-metastatic CC.
• To develop a practical management algorithm for dMMR CC.
• To aid clinical decision-making regarding immunotherapy for dMMR CC.

Main Methods:

• Systematic review of clinical trials involving neoadjuvant or adjuvant ICIs in dMMR non-metastatic CC.
• Analysis of trial results to identify key factors influencing treatment decisions.
• Development of a clinical management algorithm based on reviewed evidence.

Main Results:

• Evidence supports the efficacy and tolerability of neoadjuvant immunotherapy in dMMR CC.
• Key factors for treatment decisions include clinical status, tumor CT characteristics, and therapeutic goals.
• An algorithm was designed to guide the use of neoadjuvant or adjuvant ICIs.

Conclusions:

• Neoadjuvant immunotherapy is a viable option for dMMR CC.
• The proposed algorithm provides a framework for integrating ICIs into clinical practice.
• Personalized treatment strategies are crucial for managing dMMR CC patients.