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Neoadjuvant Immunotherapy-Based Treatment Versus Chemotherapy Alone in Resectable Locally Advanced dMMR/MSI-H Gastric
Huayang Pang1,2, Yan Chen1, Zhou Zhao1,2
1Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China.
Cancers
|June 26, 2026
Summary
Neoadjuvant immunotherapy regimens show promise for locally advanced dMMR/MSI-H gastric cancer, improving pathological response and event-free survival compared to chemotherapy alone. Further research is warranted to confirm survival benefits.
Area of Science:
- Oncology
- Gastroenterology
- Immunotherapy
Background:
- dMMR/MSI-H gastric cancer patients may benefit from immune checkpoint inhibitors (ICIs).
- Previous subgroup analyses of clinical trials have yielded inconsistent results regarding ICI efficacy.
- The translation of improved pathological response to survival benefit in this population remains unclear.
Purpose of the Study:
- To compare pathological response and survival outcomes between neoadjuvant immunotherapy regimens and chemotherapy in locally advanced dMMR/MSI-H gastric cancer.
- To evaluate the efficacy of neoadjuvant ICI monotherapy, ICI plus chemotherapy, or dual ICIs versus chemotherapy alone.
- To assess major pathological response (MPR), pathological complete response (pCR), event-free survival (EFS), and overall survival (OS).
Main Methods:
- Retrospective analysis of 24 patients with locally advanced dMMR/MSI-H gastric cancer from January 2020 to December 2025.
- Group A received neoadjuvant immunotherapy regimens (n=14); Group B received chemotherapy alone (n=10).
- A meta-analysis integrating the cohort with external studies was performed to enhance statistical power.
Main Results:
- Group A demonstrated higher MPR rates (85.7% vs. 20%) and pCR rates (42.9% vs. 0%) compared to Group B.
- Pooled analyses indicated significant improvements in MPR (RR=4.09) and pCR (RR=5.38) with immunotherapy regimens.
- Reconstructed survival data suggested improved EFS in Group A (p=0.034), while OS showed no significant difference (p=0.890).
Conclusions:
- Neoadjuvant immunotherapy-based regimens may enhance treatment response rates and EFS in locally advanced dMMR/MSI-H gastric cancer.
- These findings suggest potential therapeutic value for immunotherapy in this molecularly defined patient group.
- Further investigation is needed to solidify the survival benefits of neoadjuvant immunotherapy in this setting.
