1
|
Xia F, Wang Y, Wang H, Shen L, Xiang Z, Zhao Y, Zhang H, Wan J, Zhang H, Wang Y, Wu R, Wang J, Yang W, Zhou M, Zhou S, Chen Y, Zhang Z, Wu X, Xuan Y, Wang R, Sun Y, Tong T, Zhang X, Wang L, Huang D, Sheng W, Yan H, Yang X, Shen Y, Xu Y, Zhao R, Mo M, Cai G, Cai S, Xu Y, Zhang Z. Randomized Phase II Trial of Immunotherapy-Based Total Neoadjuvant Therapy for Proficient Mismatch Repair or Microsatellite Stable Locally Advanced Rectal Cancer (TORCH). J Clin Oncol 2024; 42:3308-3318. [PMID: 38950321 DOI: 10.1200/jco.23.02261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSETo assess whether the integration of PD-1 inhibitor with total neoadjuvant therapy (iTNT) can lead to an improvement in complete responses (CRs) and favors a watch-and-wait (WW) strategy in patients with proficient mismatch repair or microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC).PATIENTS AND METHODSWe conducted a prospective, multicenter, randomized, open-label, phase II trial using a pick-the-winner design. Eligible patients with clinical T3-4 and/or N+ rectal adenocarcinoma were randomly assigned to group A for short-course radiotherapy (SCRT) followed by six cycles of consolidation immunochemotherapy with capecitabine and oxaliplatin and toripalimab or to group B for two cycles of induction immunochemotherapy followed by SCRT and the rest four doses. Either total mesorectal excision or WW was applied on the basis of tumor response. The primary end point was CR which included pathological CR (pCR) after surgery and clinical CR (cCR) if WW was applicable, with hypothesis of an increased CR of 40% after iTNT compared with historical data of 25% after conventional TNT.RESULTSOf the 130 patients enrolled, 121 pMMR/MSS patients were evaluable (62 in group A and 59 in group B). At a median follow-up of 19 months, CR was achieved at 56.5% in group A and 54.2% in group B. Both groups fulfilled the predefined statistical hypothesis (P < .001). Both groups reported a pCR rate of 50%. Respectively, 15 patients in each group underwent WW and remained disease free. The most frequent grade 3 to 4 toxicities were thrombocytopenia and neutropenia. Patients in group A had higher rate of cCR (43.5% v 35.6%) at restaging and lower rate of grade 3 to 4 thrombocytopenia (24.2% v 33.9%) during neoadjuvant treatment.CONCLUSIONThe iTNT regimens remarkably improved CR rates in pMMR/MSS LARC compared with historical benchmark with acceptable toxicity. Up-front SCRT followed by immunochemotherapy was selected for future definitive study.
Collapse
Affiliation(s)
- Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Wang
- Department of Oncology, Tianjin Union Medical Center, Nankai University, Tianjin, China
| | - Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zuolin Xiang
- Department of Radiation Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutian Zhao
- Department of Radiation Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Huojun Zhang
- Department of Radiation Oncology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Juefeng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruiyan Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingwen Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wang Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Menglong Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shujuan Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yajie Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiyuan Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xian Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Xuan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Renjie Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yiqun Sun
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Tong Tong
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xun Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lei Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Dan Huang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Weiqi Sheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Hao Yan
- Department of Oncology, Tianjin Union Medical Center, Nankai University, Tianjin, China
| | - Xu Yang
- Department of Radiation Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuxin Shen
- Department of Radiation Oncology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yu Xu
- Department of Radiation Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ruping Zhao
- Department of Radiation Oncology, Jia Hui International Hospital, Shanghai, China
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Shanghai, China
| | - Miao Mo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guoxiang Cai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Sanjun Cai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ye Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Lin ZY, Zhang P, Chi P, Xiao Y, Xu XM, Zhang AM, Qiu XF, Wu JX, Yuan Y, Wang ZN, Qu XJ, Li X, Nie X, Yang M, Cai KL, Zhang WK, Huang Y, Sun Z, Hou ZG, Ma C, Cheng FZ, Tao KX, Zhang T. Neoadjuvant short-course radiotherapy followed by camrelizumab and chemotherapy in locally advanced rectal cancer (UNION): early outcomes of a multicenter randomized phase III trial. Ann Oncol 2024; 35:882-891. [PMID: 38964714 DOI: 10.1016/j.annonc.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/18/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Neoadjuvant short-course radiotherapy (SCRT) followed by CAPOX and camrelizumab (a programmed cell death protein 1 monoclonal antibody) has shown potential clinical activity for locally advanced rectal cancer (LARC) in a phase II trial. This study aimed to further confirm the efficacy and safety of SCRT followed by CAPOX and camrelizumab compared to long-course chemoradiotherapy (LCRT) followed by CAPOX alone as neoadjuvant treatment for LARC. PATIENTS AND METHODS In this randomized, phase III trial, patients with T3-4/N+ rectal adenocarcinoma were randomly assigned (1 : 1) to receive SCRT or long-course chemoradiotherapy (LCRT), followed by two cycles of camrelizumab and CAPOX or CAPOX alone, respectively. After surgery, each arm underwent either six cycles of camrelizumab and CAPOX, followed by up to 17 doses of camrelizumab, or six cycles of CAPOX. The primary endpoint was pathological complete response (pCR) rate (ypT0N0) assessed by a blinded independent review committee. Key secondary endpoints tested hierarchically were 3-year event-free survival (EFS) rate and overall survival (OS). RESULTS Between July 2021 and March 2023, the intention-to-treat population comprised 113 patients in the experimental arm and 118 patients in the control arm, with surgery carried out in 92% and 83.9%, respectively. At data cut-off (11 July 2023), the pCR rates were 39.8% [95% confidence interval (CI) 30.7% to 49.5%] in the experimental arm compared to 15.3% (95% CI 9.3% to 23.0%) in the control arm (difference, 24.6%; odds ratio, 3.7; 95% CI 2.0-6.9; P < 0.001). In each arm, surgical complication rates were 40.0% and 40.8%, and grade ≥3 treatment-related adverse events were 29.2% and 27.2%. Three-year EFS rate and OS continue to mature. CONCLUSIONS In LARC patients, neoadjuvant SCRT followed by camrelizumab plus CAPOX demonstrated a significantly higher pCR rate than LCRT followed by CAPOX, with a well-tolerated safety profile. SCRT followed by camrelizumab and chemotherapy can be recommended as a neoadjuvant treatment modality for these patients.
Collapse
Affiliation(s)
- Z Y Lin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - P Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - P Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou
| | - Y Xiao
- Department of Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - X M Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan
| | - A M Zhang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Hebei University, Baoding
| | - X F Qiu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, Xiamen
| | - J X Wu
- Radiotherapy Department of Abdominal Tumors, Fujian Cancer Hospital, Fuzhou
| | - Y Yuan
- Department of Medical Oncology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou
| | - Z N Wang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang
| | - X J Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang
| | - X Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - X Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - M Yang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - K L Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - W K Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Y Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou
| | - Z Sun
- Department of Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Z G Hou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - C Ma
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - F Z Cheng
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - K X Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
| | - T Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
| |
Collapse
|
3
|
Romesser PB, Cercek A. Optimizing Rectal Cancer Treatment: A Path Towards Personalization. Ann Oncol 2024; 35:831-835. [PMID: 39271253 DOI: 10.1016/j.annonc.2024.08.2349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Affiliation(s)
- Paul B Romesser
- Colorectal and Anal Cancer Service, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Department of Medicine, Gastrointestinal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
4
|
Williams CJM, Peddle AM, Kasi PM, Seligmann JF, Roxburgh CS, Middleton GM, Tejpar S. Neoadjuvant immunotherapy for dMMR and pMMR colorectal cancers: therapeutic strategies and putative biomarkers of response. Nat Rev Clin Oncol 2024:10.1038/s41571-024-00943-6. [PMID: 39317818 DOI: 10.1038/s41571-024-00943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/26/2024]
Abstract
Approximately 15% of locally advanced colorectal cancers (CRC) have DNA mismatch repair deficiency (dMMR), resulting in high microsatellite instability and a high tumour mutational burden. These cancers are frequently sensitive to therapy with immune-checkpoint inhibitors (ICIs) in the metastatic setting. This sensitivity seems to be even more pronounced in locally advanced disease, and organ preservation has become a realistic aim in ongoing clinical trials involving patients with dMMR rectal cancer. By contrast, metastatic CRCs with proficient DNA mismatch repair (pMMR) are generally resistant to ICIs, although a proportion of locally advanced pMMR tumours seem to have a high degree of sensitivity to ICIs. In this Review, we describe the current and emerging clinical evidence supporting the use of neoadjuvant ICIs in patients with dMMR and pMMR CRC, and the potential advantages (based on a biological rationale) of such an approach. We discuss how neoadjuvant 'window-of-opportunity' trials are being leveraged to progress biomarker discovery and we provide an overview of potential predictive biomarkers of response to ICIs, exploring the challenges faced when evaluating such biomarkers in biopsy-derived samples. Lastly, we describe how these discoveries might be used to drive a rational approach to trialling novel immunotherapeutic strategies in patients with pMMR CRC, with the ultimate aim of disease eradication and the generation of long-term immunosurveillance.
Collapse
Affiliation(s)
| | | | - Pashtoon M Kasi
- Department of Gastrointestinal Oncology, City of Hope Orange County Lennar Foundation Cancer Center, Irvine, CA, USA
| | - Jenny F Seligmann
- Division of Oncology, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - Gary M Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | |
Collapse
|
5
|
Xiao WW, Chen G, Gao YH, Lin JZ, Wu XJ, Luo HL, Lu ZH, Wang QX, Sun R, Cai PQ, Zhu CM, Liu M, Li JB, Wang YR, Jin Y, Wang F, Luo HT, Li CL, Pan ZZ, Xu RH. Effect of neoadjuvant chemoradiotherapy with or without PD-1 antibody sintilimab in pMMR locally advanced rectal cancer: A randomized clinical trial. Cancer Cell 2024; 42:1570-1581.e4. [PMID: 39094560 DOI: 10.1016/j.ccell.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/26/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
Neoadjuvant chemoradiotherapy (NACRT) was the standard treatment for patients with locally advanced rectal cancer (LARC) with proficient mismatch repair (pMMR) proteins. In this randomized phase 2 trial (ClinicalTrial.gov: NCT04304209), 134 pMMR LARC patients were randomly (1:1) assigned to receive NACRT or NACRT and the programmed cell death protein 1 (PD-1) antibody sintilimab. As the primary endpoint, the total complete response (CR) rate is 26.9% (18/67, 95% confidence interval [CI] 16.0%-37.8%) and 44.8% (30/67, 95% CI 32.6%-57.0%) in the control and experimental arm, respectively, with significant difference (p = 0.031 for chi-squared test). Response ratio is 1.667 (95% CI 1.035-2.683). Immunohistochemistry shows PD-1 ligand 1 (PD-L1) combined positive score is associated with the synergistic effect. The safety profile is similar between the arms. Adding the PD-1 antibody sintilimab to NACRT significantly increases the CR rate in pMMR LARC, with a manageable safety profile. PD-L1 positivity may help identify patients who might benefit most from the combination therapy.
Collapse
Affiliation(s)
- Wei-Wei Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China; United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University & Chinese Academy of Sciences Ion Medical Technology Co., Ltd, Guangzhou, China
| | - Gong Chen
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Yuan-Hong Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Jun-Zhong Lin
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xiao-Jun Wu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Hui-Long Luo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Zhen-Hai Lu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Qiao-Xuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Rui Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Pei-Qiang Cai
- Department of Radiology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Chong-Mei Zhu
- Department of Pathology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Min Liu
- Department of Ultrasound, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ji-Bin Li
- Department of Statistics, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Yi-Rui Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ying Jin
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Feng Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Hai-Tao Luo
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Cai-Ling Li
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Zhi-Zhong Pan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China.
| |
Collapse
|
6
|
Zager Y, Horesh N, Abdelmasseh M, Aquina CT, Alfonso BLL, Soliman MK, Albert MR, Monson JRT. The predicting value of post neoadjuvant treatment magnetic resonance imaging: a meta-analysis. Surg Endosc 2024:10.1007/s00464-024-11084-3. [PMID: 39174708 DOI: 10.1007/s00464-024-11084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/13/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is also used for clinical and pre-operative restaging following pre-operative treatment. In this meta-analysis, we aimed to evaluate the concordance between restaging MRI (following the completion of neoadjuvant therapy) and postoperative pathology result. METHODS We conducted a meta-analysis following the PRISMA 2020 guidelines. Two independent reviewers searched PubMed and Google Scholar for studies reporting restaging MRI results compared to pathological outcomes. Outcomes included tumor and nodal staging, circumferential resection margin (CRM) and pathological complete response (pCR). RESULTS Out of 25,000 studies found on the initial search; 33 studies were included. The studies were published between 2005 and 2023 and included 4100 patients (57.14% males). The median age was 62.45 years. The median interval between the conclusion of neoadjuvant treatment and the subsequent restaging MRI was 6 weeks (range 4.14-8.8 weeks). The pooled concordance rates between the restaging MRI and the pathological outcomes for ypT stage and ypN stage were 63.9% (54.5%-73.3%, I2 = 96.02%) and 60.9% (42.9%-78.9%, I2 = 98.96%), respectively. The pooled concordance for predicting pathological complete response was 70.4% (53.6%-87.1%, I2 = 98.21%). As for the circumferential resection margin (CRM), the pooled concordance was 78.2.% (71.6%-84.8%, I2 = 83.76%). CONCLUSIONS Our findings suggest that the concordance rates between restaging MRI and pathological outcomes in rectal cancer patients following neoadjuvant therapy are limited. Caregivers should take these results into consideration when making clinical decisions about these patients. More data should be gathered about the predictive value of MRI after total neoadjuvant therapy as well as immunotherapy in rectal cancer patients.
Collapse
Affiliation(s)
- Yaniv Zager
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA.
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA.
| | - Nir Horesh
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Michael Abdelmasseh
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Christopher T Aquina
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Bustamante Lopez Leonardo Alfonso
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Mark K Soliman
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Matthew R Albert
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - John R T Monson
- Department of Colorectal Surgery, Northwell Health, Northshore University Hospital, New York, USA
| |
Collapse
|
7
|
Gaetani RS, Ladin K, Abelson JS. Journey through the Decades: The Evolution in Treatment and Shared Decision Making for Locally Advanced Rectal Cancer. Cancers (Basel) 2024; 16:2807. [PMID: 39199579 PMCID: PMC11353159 DOI: 10.3390/cancers16162807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients' values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.
Collapse
Affiliation(s)
- Racquel S. Gaetani
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, MA 02155, USA
| | - Jonathan S. Abelson
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
| |
Collapse
|
8
|
Lynch C, Pitroda SP, Weichselbaum RR. Radiotherapy, immunity, and immune checkpoint inhibitors. Lancet Oncol 2024; 25:e352-e362. [PMID: 39089313 DOI: 10.1016/s1470-2045(24)00075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 08/03/2024]
Abstract
Radiotherapy exerts immunostimulatory and immunosuppressive effects, both locally, within the irradiated tumour microenvironment, and systemically, outside the radiation field. Inspired by preclinical data that showed synergy between radiotherapy and immune checkpoint inhibitors, multiple clinical trials were initiated with the hypothesis that combined treatment with radiotherapy and immune checkpoint inhibitors could stimulate a robust systemic immune response and improve clinical outcomes. However, despite early optimism, radioimmunotherapy trials in the curative and metastatic settings have met with little success. In this Review, we summarise the immunostimulatory effects of radiotherapy that provided the theoretical basis for trials of combination radiotherapy and immune checkpoint inhibitors. We also discuss findings from clinical trials incorporating radiotherapy and immune checkpoint inhibitors and examine the success of these trials in the context of the immunosuppressive effects of radiotherapy. We conclude by highlighting targets for relieving radiotherapy-induced immunosuppression with the goal of enhancing the combined effects of radiotherapy and immune checkpoint inhibitors.
Collapse
Affiliation(s)
- Connor Lynch
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Sean P Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
9
|
Sandow L, Tsikitis L, Lopez CD, Brinkerhoff B, Kardosh A, Pegna G, Chen EY. Neoadjuvant immunotherapy leads to complete pathologic response in locally advanced colon cancer. Clin Case Rep 2024; 12:e9218. [PMID: 39114842 PMCID: PMC11303659 DOI: 10.1002/ccr3.9218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 08/10/2024] Open
Abstract
Immunotherapy is considered first line in patients with dMMR metastatic colorectal cancer (CRC). Recent studies have also shown promising results with neoadjuvant immunotherapy in locally advanced CRC. We report a case in which neoadjuvant immunotherapy with pembrolizumab resulted in complete pathologic response at time of resection as well as saved the patient the morbidity associated with a hepatectomy. We also completed a scoping review of the literature which suggests promising tumor responses with treatment in dMMR CRC. Further randomized control trials to determine the magnitude of response and optimal regimen are needed.
Collapse
Affiliation(s)
- Lyndsey Sandow
- Department of MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Liana Tsikitis
- Division of Gastrointestinal and General Surgery, Department of General SurgeryOregon Health and Science UniversityPortlandOregonUSA
| | - Charles D. Lopez
- Division of Hematology and Medical OncologyOregon Health and Science University, Knight Cancer InstitutePortlandOregonUSA
| | - Brian Brinkerhoff
- Department of PathologyOregon Health and Science UniversityPortlandOregonUSA
| | - Adel Kardosh
- Division of Hematology and Medical OncologyOregon Health and Science University, Knight Cancer InstitutePortlandOregonUSA
| | - Guillaume Pegna
- Division of Hematology and Medical OncologyOregon Health and Science University, Knight Cancer InstitutePortlandOregonUSA
| | - Emerson Y. Chen
- Division of Hematology and Medical OncologyOregon Health and Science University, Knight Cancer InstitutePortlandOregonUSA
| |
Collapse
|
10
|
Yang Z, Ma J, Han J, Li A, Liu G, Sun Y, Zheng J, Zhang J, Chen G, Xu R, Sun L, Meng C, Gao J, Bai Z, Deng W, Zhang C, Su J, Yao H, Zhang Z. Gut microbiome model predicts response to neoadjuvant immunotherapy plus chemoradiotherapy in rectal cancer. MED 2024:S2666-6340(24)00261-7. [PMID: 39047732 DOI: 10.1016/j.medj.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/18/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Accurate evaluation of the response to preoperative treatment enables the provision of a more appropriate personalized therapeutic schedule for locally advanced rectal cancer (LARC), which remains an enormous challenge, especially neoadjuvant immunotherapy plus chemoradiotherapy (nICRT). METHODS This prospective, multicenter cohort study enrolled patients with LARC from 6 centers who received nICRT. The dynamic variation in the gut microbiome during nICRT was evaluated. A species-level gut microbiome prediction (SPEED) model was developed and validated to predict the pathological complete response (pCR) to nICRT. FINDINGS A total of 50 patients were enrolled, 75 fecal samples were collected from 33 patients at different time points, and the pCR rate reached 42.4% (14/33). Lactobacillus and Eubacterium were observed to increase after nICRT. Additionally, significant differences in the gut microbiome were observed between responders and non-responders at baseline. Significantly higher abundances of Lachnospiraceaebacterium and Blautiawexlerae were found in responders, while Bacteroides, Prevotella, and Porphyromonas were found in non-responders. The SPEED model showcased a superior predictive performance with areas under the curve of 98.80% (95% confidence interval [CI]: 95.67%-100%) in the training cohort and 77.78% (95% CI: 65.42%-88.29%) in the validation cohort. CONCLUSIONS Programmed death 1 (PD-1) blockade plus concurrent long-course CRT showed a favorable pCR rate and is well tolerated in microsatellite-stable (MSS)/mismatch repair-proficient (pMMR) patients with LARC. The SPEED model can be used to predict the pCR to nICRT based on the baseline gut microbiome with high robustness and accuracy, thereby assisting clinical physicians in providing individualized management for patients with LARC. FUNDING This research was funded by the China National Natural Science Foundation (82202884).
Collapse
Affiliation(s)
- Zhengyang Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jingxin Ma
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiagang Han
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ang Li
- Department of General Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi Sun
- Department of Anorectal, Tianjin People's Hospital, Tianjin, China
| | - Jianyong Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Jie Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guangyong Chen
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liting Sun
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Cong Meng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jiale Gao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhigang Bai
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wei Deng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Chenlin Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
| |
Collapse
|
11
|
Zhang W, Tang Y, Wei L, Liu S, Wang W, Chi Y, Wang Y, Kang W, Huang W, Deng F, Li H, Ma H, Jiang L, Ding Z, Feng L, Li Y, Chen Y, Zhou H, Hu C, Jin J. Preoperative short-course radiotherapy followed by chemotherapy and PD-1 inhibitor administration for locally advanced rectal cancer: A study protocol of a randomized phase II/III trial (STELLAR II study). Colorectal Dis 2024. [PMID: 39020518 DOI: 10.1111/codi.17090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 06/04/2024] [Accepted: 06/17/2024] [Indexed: 07/19/2024]
Abstract
AIM For patients with locally advanced rectal cancer, previous STELLAR studies have shown that a new adjuvant treatment paradigm of short-course radiotherapy followed by neoadjuvant chemotherapy can achieve pathological complete response rates superior to those of standard care; however, the 3-year DFS is inferior to neoadjuvant concurrent radiotherapy. Recent studies have shown that immune checkpoint inhibitors may improve the prognosis of rectal cancer and have good synergy with radiotherapy. Therefore, neoadjuvant chemotherapy combined with immune checkpoint inhibitors after a short course of radiotherapy has the potential to further improve complete response rates and prognosis. METHOD The STELLAR II study is a multicentre, open label, two-arm randomized, phase II/III trial of short-course radiotherapy followed by neoadjuvant chemotherapy concurrent with immunotherapy for locally advanced rectal cancer. A total of 588 patients with locally advanced rectal cancer (LARC) will be randomly assigned to the experimental and control groups. The experimental group will receive short-course radiotherapy and neoadjuvant chemotherapy in combination with sindilizumab, while the control group will receive short-course radiotherapy and neoadjuvant chemotherapy. Both groups will subsequently receive either total rectal mesenteric resection or a watch & wait (W&W) strategy. The phase II primary endpoint is the complete remission rate, and the secondary endpoints include grade 3-4 adverse events, perioperative complications, R0 resection rate, overall survival, local recurrence rate, distant metastasis rate and quality of life score. A seamless phase II/III randomized controlled design will be used to investigate the effectiveness and safety of the TNT strategy with the addition of immunotherapy. The trial opened, and the first patient was recruited on 31 August 2022. Trial registration number and date of registration: ClinicalTrials.gov NCT05484024, 29 July 2022. DISCUSSION The STELLAR II trial will prospectively evaluate the efficacy of TNT treatment strategies that incorporate immune checkpoint inhibitors. The trial will yield important information to guide routine management of patients with local advanced rectal cancer.
Collapse
Affiliation(s)
- Wenjue Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yuan Tang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Shixin Liu
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Wenling Wang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yihebali Chi
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Medical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wenyan Kang
- Department of Radiology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wenting Huang
- Department of Pathology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
- State Key Laboratory of Molecular Oncology, Department of Pathology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiyan Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Haoyue Li
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiying Ma
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - LiMing Jiang
- State Key Laboratory of Molecular Oncology, Department of Radiology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Ding
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Lingling Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yexiong Li
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinggang Chen
- Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Haitao Zhou
- State Key Laboratory of Molecular Oncology, Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Centre, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
12
|
Noticewala SS, Das P. Current State of Neoadjuvant Therapy for Locally Advanced Rectal Cancer. Cancer J 2024; 30:227-231. [PMID: 39042772 DOI: 10.1097/ppo.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
ABSTRACT In locally advanced rectal cancer, neoadjuvant treatment has evolved from no preoperative treatment to the addition of radiation and systemic therapy and ultimately total neoadjuvant therapy. Total neoadjuvant therapy is the completion of preoperative radiation or chemoradiation and chemotherapy before surgery in order to maximize tumor response and improve survival outcomes. This review summarizes the literature of the neoadjuvant approaches related to locally advanced rectal cancer and highlights the nuances of selecting the appropriate treatment.
Collapse
Affiliation(s)
- Sonal S Noticewala
- From the Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | |
Collapse
|
13
|
Wang L, Lynch C, Pitroda SP, Piffkó A, Yang K, Huser AK, Liang HL, Weichselbaum RR. Radiotherapy and immunology. J Exp Med 2024; 221:e20232101. [PMID: 38771260 PMCID: PMC11110906 DOI: 10.1084/jem.20232101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
The majority of cancer patients receive radiotherapy during the course of treatment, delivered with curative intent for local tumor control or as part of a multimodality regimen aimed at eliminating distant metastasis. A major focus of research has been DNA damage; however, in the past two decades, emphasis has shifted to the important role the immune system plays in radiotherapy-induced anti-tumor effects. Radiotherapy reprograms the tumor microenvironment, triggering DNA and RNA sensing cascades that activate innate immunity and ultimately enhance adaptive immunity. In opposition, radiotherapy also induces suppression of anti-tumor immunity, including recruitment of regulatory T cells, myeloid-derived suppressor cells, and suppressive macrophages. The balance of pro- and anti-tumor immunity is regulated in part by radiotherapy-induced chemokines and cytokines. Microbiota can also influence radiotherapy outcomes and is under clinical investigation. Blockade of the PD-1/PD-L1 axis and CTLA-4 has been extensively investigated in combination with radiotherapy; we include a review of clinical trials involving inhibition of these immune checkpoints and radiotherapy.
Collapse
Affiliation(s)
- Liangliang Wang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Connor Lynch
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Sean P. Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - András Piffkó
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kaiting Yang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Amy K. Huser
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Hua Laura Liang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Ralph R. Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| |
Collapse
|
14
|
Mitrea DA, Froicu EM, Prenen H, Gambacorta MA, Span PN, Poortmans P. Combining immunotherapy and radiation therapy in gastrointestinal cancers: A review. Crit Rev Oncol Hematol 2024; 199:104381. [PMID: 38735504 DOI: 10.1016/j.critrevonc.2024.104381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION AND PURPOSE With a significant global impact, treatment of gastrointestinal (GI) cancers still presents with challenges, despite current multimodality approaches in advanced stages. Clinical trials are expanding for checkpoint inhibition (ICI) combined with radiation therapy (RT). This review intends to offer a comprehensive image of the current data regarding the effectiveness of this association, and to reflect on possible directions to further optimize the results. RESULTS Several early phase studies demonstrated encouraging potential. However, translating preclinical outcomes to clinical settings proves challenging, especially in immunologically "cold" environments. GI cancers exhibit heterogeneity, requiring tailored approaches based on disease stage and patient characteristics. Current results, though promising, lack the power of evidence to influence the general practice. CONCLUSIONS Finding biomarkers for identifying or converting resistant cancers is essential for maximizing responses, moreover in this context strategic RT parameters need to be carefully considered. Our review emphasizes the significance of having a thorough grasp of how immunology, tumour biology, and treatment settings interact in order to propose novel research avenues and efficient GI cancer therapy.
Collapse
Affiliation(s)
- Diana A Mitrea
- Department of Radiation Oncology, Centre Antoine-Lacassagne, 33 Av. de Valombrose, Nice 06100, France.
| | - Eliza M Froicu
- Department of Medical Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Hans Prenen
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Maria A Gambacorta
- Department of Radiation Oncology Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Paul N Span
- Radiotherapy & OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| |
Collapse
|
15
|
Tsukada Y, Bando H, Inamori K, Wakabayashi M, Togashi Y, Koyama S, Kotani D, Yuki S, Komatsu Y, Homma S, Taketomi A, Uemura M, Kato T, Fukui M, Nakamura N, Kojima M, Kawachi H, Kirsch R, Yoshida T, Sato A, Nishikawa H, Ito M, Yoshino T. Three-year outcomes of preoperative chemoradiotherapy plus nivolumab in microsatellite stable and microsatellite instability-high locally advanced rectal cancer. Br J Cancer 2024; 131:283-289. [PMID: 38834744 PMCID: PMC11263387 DOI: 10.1038/s41416-024-02730-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Preoperative chemoradiotherapy (CRT) followed by surgery is the standard treatment for locally advanced rectal cancer (LARC). We reported the short-term outcomes of the VOLTAGE trial that investigated the safety and efficacy of preoperative CRT followed by nivolumab and surgery. Here, we present the 3-year outcomes of this trial. METHODS Thirty-nine patients with microsatellite stable (MSS) LARC and five patients with microsatellite instability-high (MSI-H) LARC underwent CRT (50.4 Gy) followed by five doses of nivolumab (240 mg) and surgery. The 3-year relapse-free survival (RFS), overall survival (OS), and associations with biomarkers were evaluated. RESULTS The 3-year RFS rates in patients with MSS and MSI-H were 79.5% and 100%, respectively, and the 3-year OS rates were 97.4% and 100%, respectively. Of the MSS patients, those with pre-CRT PD-L1 positivity, pre-CRT high CD8 + T cell/effector regulatory T cell (eTreg) ratio, pre-CRT high expression of Ki-67, CTLA-4, and PD-1 had a trend toward better 3-year RFS than those without. CONCLUSIONS Three-year outcomes of patients with MSI-H were better than those of patients with MSS. PD-L1 positivity, elevated CD8/eTreg ratio, and high expression of Ki-67, CTLA-4, and PD-1 could be positive predictors of prognosis in patients with MSS. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02948348.
Collapse
Affiliation(s)
- Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan.
| | - Hideaki Bando
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan
| | - Koji Inamori
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo/Kashiwa, 104-0045/277-8587, Japan
| | - Masashi Wakabayashi
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, 277-8587, Japan
| | - Yosuke Togashi
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo/Kashiwa, 104-0045/277-8587, Japan
| | - Shohei Koyama
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo/Kashiwa, 104-0045/277-8587, Japan
| | - Daisuke Kotani
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan
| | - Satoshi Yuki
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, 060-8648, Japan
| | - Yoshito Komatsu
- Department of Cancer chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, 060-8648, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery, Hokkaido University Hospital, Sapporo, 060-8648, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery, Hokkaido University Hospital, Sapporo, 060-8648, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, 540-0006, Japan
| | - Makoto Fukui
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, 277-8587, Japan
| | - Naoki Nakamura
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, 277-8587, Japan
- Department of Radiation Oncology, St. Marianna University Hospital, Kawasaki, 216-8511, Japan
| | - Motohiro Kojima
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, 277-8587, Japan
| | - Hiroshi Kawachi
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, 135-8550, Japan
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, M5G 1×5, Canada
| | - Tsutomu Yoshida
- Division of Molecular Pathology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, 252-0374, Japan
| | - Akihiro Sato
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, 277-8587, Japan
| | - Hiroyoshi Nishikawa
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo/Kashiwa, 104-0045/277-8587, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan
| |
Collapse
|
16
|
Zhou S, Horita N, Shao T, Harrington M, Fujiwara Y. Endocrine adverse events in patients with cancer receiving perioperative immune checkpoint blockade: a meta-analysis of randomized controlled trials. Ther Adv Med Oncol 2024; 16:17588359241257874. [PMID: 38845790 PMCID: PMC11155360 DOI: 10.1177/17588359241257874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
Background Perioperative use of immune checkpoint blockade (ICB) improves survival in patients with early-stage cancer. Treatment-related adverse events (AEs), frequently involve the endocrine system which may increase perioperative complications and affect quality of life. Objective We conducted a meta-analysis to elucidate the impact of adding ICB to conventional neoadjuvant/adjuvant therapy on the incidence of endocrine AEs. Design A systematic review and meta-analysis of randomize-controlled trials (RCTs). Data sources and methods A systematic search of PubMed, Embase, Web of Science, and Cochrane library was performed for RCTs comparing groups with and without the addition of ICB to conventional perioperative therapy in patients with cancer. Outcomes included all-grade and grade 3-5 thyroiditis, hyperthyroidism, hypothyroidism, adrenal insufficiency, hypophysitis, type 1 diabetes mellitus, and hyperglycemia. The odds ratios (ORs) of all-grade and grade 3-5 endocrine were pooled using the random-effect model meta-analysis. Results Twenty-four RCTs comprising 12,199 patients were identified for meta-analysis. The addition of ICB was associated with higher incidence of thyroiditis [all grade: OR = 3.53 (95% confidence interval (CI): 1.88-6.64)], hyperthyroidism [all-grade: 7.18 (4.30-12.01); grade 3-5: 3.93 (1.21-12.82)], hypothyroidism [all-grade: 5.39 (3.68-7.90); grade 3-5: 3.63 (1.18-11.11)], adrenal insufficiency [all-grade: 3.82 (1.88-7.79); grade 3-5: 5.91 (2.36-14.82)], hypophysitis [all-grade: 10.29 (4.97-21.3); grade 3-5: 5.80 (1.99-16.92)], and type 1 diabetes mellitus [all-grade: 2.24 (1.06-4.74); grade 3-5: 3.49 (1.21-10.08)]. The cumulative incidence of each grade 3-5 endocrine AE was low (<1.3%). No grade 5 AEs leading to death were observed. Conclusion The addition of neoadjuvant/adjuvant ICB to conventional therapy was associated with an increased incidence of several endocrine AEs. Clinicians should be aware of the risk of endocrinopathy from the perioperative ICB use to facilitate risk-benefit discussion with patients with early-stage cancer. Trial registration The protocol of this research was registered in PROSPERO (CRD42022332624).
Collapse
Affiliation(s)
- Susu Zhou
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama, Japan
| | - Theresa Shao
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Harrington
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Yu Fujiwara
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Street, Buffalo, NY 14263, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| |
Collapse
|
17
|
Jin Y, Jiang J, Mao W, Bai M, Chen Q, Zhu J. Treatment strategies and molecular mechanism of radiotherapy combined with immunotherapy in colorectal cancer. Cancer Lett 2024; 591:216858. [PMID: 38621460 DOI: 10.1016/j.canlet.2024.216858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
Radiotherapy (RT) remodels the tumor immune microenvironment (TIME) and modulates the immune response to indirectly destroy tumor cells, in addition to directly killing tumor cells. RT combined with immunotherapy may significantly enhance the efficacy of RT in colorectal cancer by modulating the microenvironment. However, the molecular mechanisms by which RT acts as an immunomodulator to modulate the immune microenvironment remain unclear. Further, the optimal modalities of RT combined with immunotherapy for the treatment of colorectal cancer, such as the time point of combining RT and immunization, the fractionation pattern and dosage of radiotherapy, and other methods to improve the efficacy, are also being explored parallelly. To address these aspects, in this review, we summarized the mechanisms by which RT modulates TIME and concluded the progress of RT combined with immunization in preclinical and clinical trials. Finally, we discussed heavy ion radiation therapy and the efficacy of prediction markers and other immune combination therapies. Overall, combining RT with immunotherapy to enhance antitumor effects will have a significant clinical implication and will help to facilitate individualized treatment modalities.
Collapse
Affiliation(s)
- Yuzhao Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310000, China; Wenzhou Medical University, Wenzhou, 325000, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences Hangzhou, 310000, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310000, China
| | - Jin Jiang
- Department of Oncology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, 31400, China
| | - Wei Mao
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310000, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences Hangzhou, 310000, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310000, China
| | - Minghua Bai
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310000, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310000, China
| | - Qianping Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310000, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences Hangzhou, 310000, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310000, China.
| | - Ji Zhu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310000, China; Wenzhou Medical University, Wenzhou, 325000, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences Hangzhou, 310000, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310000, China.
| |
Collapse
|
18
|
Park R, Saeed A. Immunotherapy in Colorectal Cancer - Finding the Achilles' Heel. NEJM EVIDENCE 2024; 3:EVIDra2300353. [PMID: 38804784 DOI: 10.1056/evidra2300353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
AbstractColorectal cancer treatment has evolved considerably in the last decade with the development of immunotherapies. Immune checkpoint inhibitor therapies have brisk and durable responses in patients with advanced microsatellite instability-high colorectal cancer, both surgically resectable and unresectable; however, patients with microsatellite stable colorectal cancer in general do not respond to the same therapy. Emerging evidence shows that immune checkpoint inhibitors may elicit responses in subsets of patients with microsatellite stable colorectal cancer, especially when combined with other anticancer agents that can modulate the tumor microenvironment. Therefore, rationally designed therapeutic combinations involving immune checkpoint inhibitors, as well as the development of predictive biomarkers for optimal patient selection, have emerged as two key areas of active research. In addition, other immunotherapeutic agents such as cell-based therapies and bispecific T-cell engagers are beginning to be studied in preclinical and early-phase settings. Although by no means a universal treatment strategy, immunotherapy can elicit responses in microsatellite stable colorectal cancer and further research is needed to extend their benefit to patients with microsatellite stable colorectal cancer. Here, we review the current state of immunotherapeutic regimens for microsatellite stable colorectal cancer.
Collapse
Affiliation(s)
- Robin Park
- Division of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL
- Department of Medicine, University of South Florida, Tampa, FL
| | - Anwaar Saeed
- Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh
- UPMC Hillman Cancer Center, Pittsburgh
| |
Collapse
|
19
|
Anker CJ, Tchelebi LT, Selfridge JE, Jabbour SK, Akselrod D, Cataldo P, Abood G, Berlin J, Hallemeier CL, Jethwa KR, Kim E, Kennedy T, Lee P, Sharma N, Small W, Williams VM, Russo S. Executive Summary of the American Radium Society on Appropriate Use Criteria for Nonoperative Management of Rectal Adenocarcinoma: Systematic Review and Guidelines. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00673-4. [PMID: 38797496 DOI: 10.1016/j.ijrobp.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/15/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
For patients with rectal cancer, the standard approach of chemotherapy, radiation therapy, and surgery (trimodality therapy) is associated with significant long-term toxicity and/or colostomy for most patients. Patient options focused on quality of life (QOL) have dramatically improved, but there remains limited guidance regarding comparative effectiveness. This systematic review and associated guidelines evaluate how various treatment strategies compare to each other in terms of oncologic outcomes and QOL. Cochrane and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology were used to search for prospective and retrospective trials and meta-analyses of adequate quality within the Ovid Medline database between January 1, 2012, and June 15, 2023. These studies informed the expert panel, which rated the appropriateness of various treatments in 6 clinical scenarios through a well-established consensus methodology (modified Delphi). The search process yielded 197 articles that advised voting. Increasing data have shown that nonoperative management (NOM) and primary surgery result in QOL benefits noted over trimodality therapy without detriment to oncologic outcomes. For patients with rectal cancer for whom total mesorectal excision would result in permanent colostomy or inadequate bowel continence, NOM was strongly recommended as usually appropriate. Restaging with tumor response assessment approximately 8 to 12 weeks after completion of radiation therapy/chemoradiation therapy was deemed a necessary component of NOM. The panel recommended active surveillance in the setting of a near-complete or complete response. In the setting of NOM, 54 to 56 Gy in 27 to 31 fractions concurrent with chemotherapy and followed by consolidation chemotherapy was recommended. The panel strongly recommends primary surgery as usually appropriate for a T3N0 high rectal tumor for which low anterior resection and adequate bowel function is possible, with adjuvant chemotherapy considered if N+. Recent data support NOM and primary surgery as important options that should be offered to eligible patients. Considering the complexity of multidisciplinary management, patients should be discussed in a multidisciplinary setting, and therapy should be tailored to individual patient goals/values.
Collapse
Affiliation(s)
- Christopher J Anker
- Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont
| | - Leila T Tchelebi
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
| | - J Eva Selfridge
- Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute, New Brunswick, New Jersey
| | - Dmitriy Akselrod
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Peter Cataldo
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Gerard Abood
- Department of Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Jordan Berlin
- Division of Hematology Oncology, Department of Medicine Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | | | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ed Kim
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Timothy Kennedy
- Department of Surgery, Rutgers Cancer Institute, New Brunswick, New Jersey
| | - Percy Lee
- Department of Radiation Oncology, City of Hope National Medical Center, Los Angeles, California
| | - Navesh Sharma
- Department of Radiation Oncology, WellSpan Cancer Center, York, Pennsylvania
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Vonetta M Williams
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, New York
| | - Suzanne Russo
- Department of Radiation Oncology, MetroHealth, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
20
|
Gervaso L, Ciardiello D, Oliveira RA, Borghesani M, Guidi L, Benini L, Algeri L, Spada F, Zampino MG, Cella CA, Fazio N. Immunotherapy in the neoadjuvant treatment of gastrointestinal tumors: is the time ripe? J Immunother Cancer 2024; 12:e008027. [PMID: 38782539 PMCID: PMC11116869 DOI: 10.1136/jitc-2023-008027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) revolutionized the management of mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) gastrointestinal (GI) cancers. Based on notable results observed in the metastatic setting, several clinical trials investigated ICIs as neoadjuvant treatment (NAT) for localized dMMR/MSI-H GI cancers, achieving striking results in terms of clinical and pathological responses and creating the opportunity to spare patients from neoadjuvant chemotherapy and/or radiotherapy and even surgical resection. Nevertheless, these impressive findings are mainly derived from small proof of concept phase II studies and there are still several open questions to address. Moreover, dMMR/MSI-H represents a limited subgroup accounting for less than 10% of GI cancers. Consequently, many efforts have been produced to investigate neoadjuvant ICIs also in mismatch repair-proficient/microsatellite stable (MSS) cancers, considering the potential synergistic effect in combining immune-targeted agents with standard therapies such as chemo and/or radiotherapy. However, results for combining ICIs to the standard of care in the unselected population are still unsatisfactory, without improvements in event-free survival in esophago-gastric adenocarcinoma for the addition of pembrolizumab to chemotherapy, and sometimes limited benefit in patients with locally advanced rectal cancer. Therefore, a major challenge will be to identify among the heterogenous spectrum of this disease, those patients that could take advantage of neoadjuvant immunotherapy and deliver the most effective treatment. In this review we discuss the rationale of NAT in GI malignancies, summarize the available evidence regarding the completed trials that evaluated this treatment strategy in both MSI-H and MSS tumors. Finally, we discuss ongoing studies and future perspectives to render neoadjuvant immunotherapy another arrow in the quiver for the treatment of locally advanced GI tumors.
Collapse
Affiliation(s)
- Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
- Molecular Medicine Program, University of Pavia, Pavia, Lombardia, Italy
| | - Davide Ciardiello
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | | | - Michele Borghesani
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Lorenzo Guidi
- Division of New Drugs and Early Drug Development for Innovative Therapies, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Lavinia Benini
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Laura Algeri
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Maria Giulia Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO IRCCS, European Institute of Oncology, Milano, Italy
| |
Collapse
|
21
|
Yang L, Cui X, Wu F, Chi Z, Xiao L, Wang X, Liang Z, Li X, Yu Q, Lin X, Gao C. The efficacy and safety of neoadjuvant chemoradiotherapy combined with immunotherapy for locally advanced rectal cancer patients: a systematic review. Front Immunol 2024; 15:1392499. [PMID: 38846948 PMCID: PMC11154111 DOI: 10.3389/fimmu.2024.1392499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/23/2024] [Indexed: 06/09/2024] Open
Abstract
Background Several studies have explored the effectiveness of PD-1/PD-L1 inhibitors combined with neoadjuvant chemoradiotherapy (nCRT) in the treatment of locally advanced rectal cancer(LARC), particularly in microsatellite stable(MSS) or mismatch repair proficient(pMMR) LARC patients. We undertook a single-arm systematic review to comprehensively evaluate the advantages and potential risks associated with the use of PD-1/PD-L1 inhibitors in conjunction with nCRT for patients diagnosed with locally advanced rectal cancer. Methods The PubMed, Embase, Cochrane Library, ClinicalTrials.gov, ASCO and ESMO were searched for related studies. The main outcomes were pathologic complete response (pCR), major pathological response (MPR), anal preservation, and adverse effects (AEs). Results Fourteen articles including 533 locally advanced rectal cancer (LARC) patients were analyzed. The pooled pCR, MPR, and anal preservation rates were 36%, 66% and 86%. Grade ≥3 adverse events occurred in 20%. Subgroup analysis showed that; dMMR/MSI-H had a pooled pCR (100%) and MPR (100%), pMMR/MSS had a pooled pCR (38%) and MPR (60%); the short-course radiotherapy and long-course radiotherapy had pooled pCR rates of 51% and 30%, respectively. The rates of pCR for the concurrent and sequential immuno-chemoradiotherapy subgroups at 30% and 40%, mirroring pCR rates for the PD-L1 and PD-1 inhibitor subgroups were 32% and 40%, respectively. Conclusion In cases of locally advanced rectal cancer, PD-1/PD-L1 inhibitors combined with neoadjuvant chemoradiotherapy have shown promising response rates and acceptable toxicity profiles. PD-1/PD-L1 inhibitors combined with neoadjuvant chemoradiotherapy hence has a positive outcome even in MSS LARC patients. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023465380.
Collapse
Affiliation(s)
- Lei Yang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiujing Cui
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fengpeng Wu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zifeng Chi
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Linlin Xiao
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuan Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zezheng Liang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoning Li
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qiyao Yu
- Department of Research, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xueqin Lin
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Gao
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
22
|
Li Y, Pan C, Gao Y, Zhang L, Ji D, Cui X, Zhang X, Cai Y, Zhang Y, Yao Y, Wang L, Leng J, Zhan T, Wu D, Gao Z, Sun YS, Li Z, Luo H, Wu A. Total Neoadjuvant Therapy With PD-1 Blockade for High-Risk Proficient Mismatch Repair Rectal Cancer. JAMA Surg 2024; 159:529-537. [PMID: 38381429 PMCID: PMC10882505 DOI: 10.1001/jamasurg.2023.7996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024]
Abstract
Importance Total neoadjuvant therapy (TNT) is the standard treatment for locally advanced rectal cancer, especially for patients with high-risk factors. However, the efficacy of TNT combined with immunotherapy for patients with proficient mismatch repair (pMMR) rectal cancer is unknown. Objectives To evaluate the safety and efficacy of TNT with induction chemoimmunotherapy followed by long-course chemoradiation in patients with high-risk, pMMR rectal cancer and to identify potential molecular biomarkers associated with treatment efficacy. Design, Setting, and Participants This cohort study was a single-arm phase 2 trial conducted at Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, from June 2020 to October 2021. Biopsies and plasma were collected before treatment for whole-exome sequencing and cell-free DNA sequencing, respectively. Data were analyzed from May 2022 to September 2022. Interventions Participants received 3 cycles of induction oxaliplatin and capecitabine combined with camrelizumab and radiotherapy (50.6 Gy in 22 fractions) with concurrent capecitabine. Patients without disease progression received 2 cycles of consolidation oxaliplatin/capecitabine. Main Outcomes and Measures The primary end point was pathologic complete response rate. Results Of 25 patients enrolled (19 men [76%]; 6 women [24%]; median [IQR] age, 58 [48-64] years), 22 patients (88%) completed the TNT schedule. The pathologic complete response rate was 33.3% (7/21). Twelve patients (48%) achieved clinical complete response, and 4 patients (16%) chose to watch and wait. R0 resection was achieved in 21 of 21 patients, and the major pathologic response rate was 38.1% (8/21). The most common adverse event was nausea (80%, 20/25); grade 3 toxic effects occurred in 9 of 25 patients (36%). Patients with tumor shrinkage of 50% or greater after induction oxaliplatin/capecitabine and camrelizumab or clinical complete response had higher percentages of LRP1B mutation. Mutation of LRP1B was associated with high tumor mutation burden and tumor neoantigen burden. Patients with high tumor mutation burden all benefited from therapy. Conclusions and Relevance This study found that TNT with induction chemoimmunotherapy followed by long-course chemoradiation was safe and effective for patients with high-risk rectal cancer with pMMR status. Longer follow-up and larger clinical studies are needed to validate this innovative regimen. There is also an urgent need to further validate the predictive value of LRP1B and discover other novel biomarkers with potential predictive value for rectal cancer.
Collapse
Affiliation(s)
- Yingjie Li
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chaohu Pan
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Southern University of Science and Technology, Shenzhen, China
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology, Shenzhen, China
| | - Yuye Gao
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Pathology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China
| | - Dengbo Ji
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoli Cui
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology, Shenzhen, China
| | - Xiaoyan Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Radiology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China
| | - Yong Cai
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Radiation Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China
| | - Yangzi Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Radiation Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China
| | - Yunfeng Yao
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lin Wang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiahua Leng
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Tiancheng Zhan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Dongfang Wu
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology, Shenzhen, China
| | - Zhibo Gao
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology, Shenzhen, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Radiology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Pathology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China
| | - Haitao Luo
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology, Shenzhen, China
| | - Aiwen Wu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| |
Collapse
|
23
|
Pennel K, Dutton L, Melissourgou-Syka L, Roxburgh C, Birch J, Edwards J. Novel radiation and targeted therapy combinations for improving rectal cancer outcomes. Expert Rev Mol Med 2024; 26:e14. [PMID: 38623751 PMCID: PMC11140547 DOI: 10.1017/erm.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
Neoadjuvant radiotherapy (RT) is commonly used as standard treatment for rectal cancer. However, response rates are variable and survival outcomes remain poor, highlighting the need to develop new therapeutic strategies. Research is focused on identifying novel methods for sensitising rectal tumours to RT to enhance responses and improve patient outcomes. This can be achieved through harnessing tumour promoting effects of radiation or preventing development of radio-resistance in cancer cells. Many of the approaches being investigated involve targeting the recently published new dimensions of cancer hallmarks. This review article will discuss key radiation and targeted therapy combination strategies being investigated in the rectal cancer setting, with a focus on exploitation of mechanisms which target the hallmarks of cancer.
Collapse
Affiliation(s)
- Kathryn Pennel
- School of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1BD, UK
| | - Louise Dutton
- School of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1BD, UK
| | - Lydia Melissourgou-Syka
- School of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1BD, UK
- CRUK Scotland Institute, Glasgow, G611BD, UK
| | - Campbell Roxburgh
- School of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1BD, UK
- Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, G4 0SF, UK
| | - Joanna Birch
- School of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1BD, UK
| | - Joanne Edwards
- School of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1BD, UK
| |
Collapse
|
24
|
Wisdom AJ, Barker CA, Chang JY, Demaria S, Formenti S, Grassberger C, Gregucci F, Hoppe BS, Kirsch DG, Marciscano AE, Mayadev J, Mouw KW, Palta M, Wu CC, Jabbour SK, Schoenfeld JD. The Next Chapter in Immunotherapy and Radiation Combination Therapy: Cancer-Specific Perspectives. Int J Radiat Oncol Biol Phys 2024; 118:1404-1421. [PMID: 38184173 DOI: 10.1016/j.ijrobp.2023.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
Immunotherapeutic agents have revolutionized cancer treatment over the past decade. However, most patients fail to respond to immunotherapy alone. A growing body of preclinical studies highlights the potential for synergy between radiation therapy and immunotherapy, but the outcomes of clinical studies have been mixed. This review summarizes the current state of immunotherapy and radiation combination therapy across cancers, highlighting existing challenges and promising areas for future investigation.
Collapse
Affiliation(s)
- Amy J Wisdom
- Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joe Y Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sandra Demaria
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Clemens Grassberger
- Department of Radiation Oncology, University of Washington, Fred Hutch Cancer Center, Seattle, Washington
| | - Fabiana Gregucci
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - David G Kirsch
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ariel E Marciscano
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jyoti Mayadev
- Department of Radiation Oncology, UC San Diego School of Medicine, San Diego, California
| | - Kent W Mouw
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Manisha Palta
- Department of Radiation Oncology, Duke Cancer Center, Durham, North Carolina
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
| |
Collapse
|
25
|
Yang W, Qian C, Luo J, Chen C, Feng Y, Dai N, Li X, Xiao H, Yang Y, Li M, Li C, Wang D. Efficacy and Safety of Preoperative Transcatheter Rectal Arterial Chemoembolisation in Patients with Locally Advanced Rectal Cancer: Results from a Prospective, Phase II PCAR Trial. Clin Oncol (R Coll Radiol) 2024; 36:233-242. [PMID: 38342657 DOI: 10.1016/j.clon.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
AIMS The PCAR study aimed to assess the efficacy and safety of preoperative transcatheter rectal arterial chemoembolisation (TRACE) in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS This was a single-centre, prospective, phase II trial conducted in China. Eligible patients were adults aged 18 years and older with histologically confirmed stage II or III rectal carcinoma and an Eastern Cooperative Oncology Group performance status of 0-1. Patients received TRACE with oxaliplatin, followed by radiotherapy with a cumulative dose of 45 Gy (1.8 Gy/time/day, five times a week for 5 weeks) and received oral S1 capsules twice daily (7 days a week for 4 weeks). Patients underwent total mesorectal excision 4-8 weeks after the completion of chemoradiotherapy, followed by mFOLFOX6 or CAPOX regimens for 4-6 months. The hypothesis of this study was that adding TRACE to preoperative neoadjuvant chemoradiotherapy would improve tumour regression and prognosis. The primary end point was the pathological complete response rate; secondary end points included the major pathological response rate, anal preservation rate, 5-year disease-free survival (DFS), 5-year overall survival and treatment-related adverse events. RESULTS In total, 111 LARC patients received TRACE and subsequent scheduled treatment plans. The pathological complete response and major pathological response rates were 20.72% and 48.65%, respectively. The 5-year DFS and 5-year overall survival were 61.89% (95% confidence interval 51.45-74.45) and 74.80% (95% confidence interval 65.05-86.01), respectively. Grade 3-4 toxicities were reported in 29 patients (26.13%). The postoperative complication rate was 21.62%, without serious surgical complications. Multivariate Cox regression analysis showed that ypN stage (hazard ratio = 4.242, 95% confidence interval 2.101-8.564, P = 0.00017) and perineural invasion (hazard ratio = 2.319, 95% confidence interval 1.058-5.084, P = 0.0487) were independent risk factors associated with DFS, whereas ypN stage (hazard ratio = 3.164, 95% confidence interval 1.347-7.432, P = 0.0101), perineural invasion (hazard ratio = 4.118, 95% confidence interval 1.664-10.188, P = 0.0134) and serum carbohydrate antigen 199 (CA199; hazard ratio = 4.142, 95% confidence interval 1.290-13.306, P = 0.0344) were independent predictors for overall survival. CONCLUSION The current study provides evidence that adding TRACE to neoadjuvant chemoradiotherapy can improve the pathological remission rate in LARC patients with acceptable toxicity. Given its promising effectiveness and safe profile, incorporating TRACE into the standard treatment strategy for patients with LARC should be considered.
Collapse
Affiliation(s)
- W Yang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - C Qian
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - J Luo
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - C Chen
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Y Feng
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - N Dai
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - X Li
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - H Xiao
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Y Yang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - M Li
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - C Li
- Department of General Surgery, Colorectal Division, Daping Hospital, Army Medical University, Chongqing, China
| | - D Wang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China.
| |
Collapse
|
26
|
Liu Y, Jiang X, Wu Y, Yu H. Global research landscape and trends of cancer radiotherapy plus immunotherapy: A bibliometric analysis. Heliyon 2024; 10:e27103. [PMID: 38449655 PMCID: PMC10915415 DOI: 10.1016/j.heliyon.2024.e27103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/04/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
The aim of this study was to present current research trends on the synergistic use of radiotherapy and immunotherapy (IRT) for cancer treatment. On March 1, 2023, we conducted a literature search for IRT papers using the Web of Science database. We extracted information and constructed two databases - the Core Database (CD) with 864 papers and Generalized Database (GD) with 6344 papers. A bibliometric analysis was performed to provide insights into the research landscape, to identify emerging trends and highly cited papers and journals in the field of IRT. The CD contained 864 papers that were collectively cited 31,818 times. Prominent journals in this area included the New England Journal of Medicine, Lancet Oncology, and the Journal of Clinical Oncology. Corresponding authors from the USA contributed the most publications. In recent years, lung cancer, melanoma, stereotactic radiotherapy, immune checkpoint inhibitors, and the tumor microenvironment emerged as hot research areas. This bibliometric analysis presented quantitative insights into research concerning IRT and proposed potential avenues for further exploration. Moreover, researchers can use our findings to select appropriate journals for publication or identify prospective collaborators. In summary, this bibliometric analysis provides a comprehensive overview of the historical progression and recent advancements in IRT research that may serve as inspiration for future investigations.
Collapse
Affiliation(s)
- Yanhao Liu
- School of Basic Medicine, Qingdao University, Qingdao, China
- Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
| | - Xu Jiang
- Department of Nuclear Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
| | - Yujuan Wu
- Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
| | - Haiming Yu
- Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
| |
Collapse
|
27
|
Yang Z, Gao J, Zheng J, Han J, Li A, Liu G, Sun Y, Zhang J, Chen G, Xu R, Zhang X, Liu Y, Bai Z, Deng W, He W, Yao H, Zhang Z. Efficacy and safety of PD-1 blockade plus long-course chemoradiotherapy in locally advanced rectal cancer (NECTAR): a multi-center phase 2 study. Signal Transduct Target Ther 2024; 9:56. [PMID: 38462629 PMCID: PMC10925604 DOI: 10.1038/s41392-024-01762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Adding PD-1 blockade in the neoadjuvant regimens for locally advanced rectal cancer (LARC) patients with microsatellite stable (MSS) / mismatch repair-proficient (pMMR) tumors is an attractive, but debatable strategy. This phase 2, multicenter, prospective, single-arm study enrolled patients from 6 centers from June 2021 to November 2022. Locally advanced rectal cancer (LARC, cT3-4aN0M0 and cT1-4aN1-2M0) patients aged ≥18 years with the distance from distal border of tumor to anal verge ≤10 cm (identified by Magnetic Resonance Imaging) were qualified for inclusion. The patients received long-course radiotherapy (50 Gy/25 fractions, 2 Gy/fraction, 5 days/week) and three 21-day cycles capecitabine (850-1000 mg/m2, bid, po, day1-14) and three 21-day cycles tislelizumab (200 mg, iv.gtt, day8) as neoadjuvant. Total mesorectal excision (TME) was 6-12 weeks after the end of radiotherapy to achieve radical resection. A total of 50 patients were enrolled in this study. The pathological complete response rate was 40.0% [20/50, 95% confidence interval (CI): 27.61-53.82%], while 15 (30.0%, 95% CI: 19.1-43.75%), 9 (18.0%, 95% CI: 9.77-30.8%), 2 (4.0%, 95% CI: 1.10-13.46%) patients respectively achieved grade 1, 2, and 3 tumor regression. Treatment-related adverse events (TRAEs) occurred in 28 (56.0%) LARC patients, including 26(52.0%) with grade I-II and 2 (4.0%) with grade III (1 with grade 3 immune-related colitis and 1 with grade 3 rash). PD-1 blockade plus long-course chemoradiotherapy (CRT) showed promising therapeutic effects according to pathological complete response rate and is well-tolerated in LARC patients. A larger randomized controlled study is desired to further validate the above findings.
Collapse
Affiliation(s)
- Zhengyang Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jiale Gao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jianyong Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Jiagang Han
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ang Li
- Department of General Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi Sun
- Department of Anorectal, Tianjin People's Hospital, Tianjin, China
| | - Jie Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guangyong Chen
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Yishan Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhigang Bai
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wei Deng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wei He
- Department of Thoracic Surgery / Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
| |
Collapse
|
28
|
Ghiringhelli F, Rébé C. Using immunogenic cell death to improve anticancer efficacy of immune checkpoint inhibitors: From basic science to clinical application. Immunol Rev 2024; 321:335-349. [PMID: 37593811 DOI: 10.1111/imr.13263] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
Even though the discovery of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, a high proportion of patients do not respond. Moreover, some types of cancers are refractory to these treatments. Thus, the need to find predictive biomarkers of efficacy and to evaluate the association with other treatments, such as chemotherapy or radiotherapy, appears to be essential. Because ICIs reactivate or maintain an active status of T cells, one possibility is to combine these treatments with therapies that engage an immune response against tumor cells. Thus, by inducing immunogenic cell death (ICD) of cancer cells, some conventional anticancer treatments induce such immune response and may have an interest to be combined with ICIs. In this review, we explore preclinical studies and clinical trials that evaluate the combination of ICIs with ICD inducers. More than inducing ICD, some of these treatments appear to modulate the tumor microenvironment and more particularly to inhibit immunosuppression, thus improving treatment efficacy.
Collapse
Affiliation(s)
- François Ghiringhelli
- Cancer Biology Transfer Platform, Centre Georges-François Leclerc, Dijon, France
- Equipe TIRECs, Labellisée Ligue Contre le Cancer, Centre de Recherche INSERM LNC-UMR1231, Dijon, France
- University of Bourgogne Franche-Comté, Dijon, France
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
- Genetic and Immunology Medical Institute, Dijon, France
| | - Cédric Rébé
- Cancer Biology Transfer Platform, Centre Georges-François Leclerc, Dijon, France
- Equipe TIRECs, Labellisée Ligue Contre le Cancer, Centre de Recherche INSERM LNC-UMR1231, Dijon, France
- University of Bourgogne Franche-Comté, Dijon, France
| |
Collapse
|
29
|
Fujiwara Y, Horita N, Adib E, Zhou S, Nassar AH, Asad ZUA, Cortellini A, Naqash AR. Treatment-related adverse events, including fatal toxicities, in patients with solid tumours receiving neoadjuvant and adjuvant immune checkpoint blockade: a systematic review and meta-analysis of randomised controlled trials. Lancet Oncol 2024; 25:62-75. [PMID: 38012893 DOI: 10.1016/s1470-2045(23)00524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Incorporating immune checkpoint blockade into perioperative cancer therapy has improved clinical outcomes. However, the safety of immune checkpoint blockade needs better evaluation, given the chances of more prolonged disease-free survival. We aimed to assess how adding immune checkpoint blockade to perioperative therapy affects treatment-related adverse events. METHODS For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library from database inception until Aug 8, 2023, for randomised controlled trials that assessed the addition of immune checkpoint blockade to neoadjuvant or adjuvant therapy for cancer, reported treatment-related deaths, and had a design in which the experimental group assessed immune checkpoint blockade in combination with the therapy used in the control group. Meta-analysis was done to pool odds ratios (ORs) of treatment-related deaths, any grade and grade 3-4 treatment-related adverse events, serious adverse events, and adverse events leading to treatment discontinuation. The protocol is registered with PROSPERO, CRD42022343741. FINDINGS 28 randomised controlled trials with 16 976 patients were included. The addition of immune checkpoint blockade was not significantly associated with increased treatment-related deaths (OR 1·76, 95% CI 0·95-3·25; p=0·073), consistent across immune checkpoint blockade subtype (I2=0%). 40 fatal toxicities were identified across 9864 patients treated with immune checkpoint blockade, with pneumonitis being the most common (six [15·0%]); 13 fatal toxicities occurred among 7112 patients who were not treated with immune checkpoint blockade. The addition of immune checkpoint blockade increased the incidence of grade 3-4 treatment-related adverse events (OR 2·73, 95% CI 1·98-3·76; p<0·0001), adverse events leading to treatment discontinuation (3·67, 2·45-5·51; p<0·0001), and treatment-related adverse events of any grade (2·60 [1·88-3·61], p<0·0001). The immune checkpoint blockade versus placebo design primarily used as adjuvant therapy was associated with increased incidence of treatment-related deaths (4·02, 1·04-15·63; p=0·044) and grade 3-4 adverse events (5·31, 3·08-9·15; p<0·0001), whereas the addition of immune checkpoint blockade in the neoadjuvant setting was not associated with increased incidence of treatment-related death (1·11, 95% CI 0·38-3·29; p=0·84) or grade 3-4 adverse events (1·17, 0·90-1·51; p=0·23). INTERPRETATION The addition of immune checkpoint blockade to perioperative therapy was associated with an increase in grade 3-4 treatment-related adverse events and adverse events leading to treatment discontinuation. These findings provide safety insights for further clinical trials assessing neoadjuvant or adjuvant immune checkpoint blockade therapy. Clinicians should closely monitor patients for treatment-related adverse events to prevent treatment discontinuations and morbidity from these therapies in earlier-stage settings. FUNDING None.
Collapse
Affiliation(s)
- Yu Fujiwara
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA; Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Kanazawa-ku, Yokohama, Japan
| | - Elio Adib
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susu Zhou
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Amin H Nassar
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT, USA
| | - Zain Ul Abideen Asad
- Department of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA.
| |
Collapse
|
30
|
Lv M, Ding R, Ma P, Feng Y, Zeng S, Zhang Y, Shen W, Guan W, Xiangyu E, Zeng H, Yu J. Network Pharmacology Analysis on the Mechanism of Xihuangwan in Treating Rectal Cancer and Radiation Enteritis. Curr Pharm Des 2024; 30:683-701. [PMID: 38415445 DOI: 10.2174/0113816128287232240213105913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Recent studies have shown that XihuangWan (XHW) is a kind of Chinese medicine with significant anti-tumor and anti-inflammatory activities. However, its mechanism for preventing and treating radiation proctitis in rectal cancer patients during radiotherapy remains unclear. METHODS This study employed the network pharmacology to establish a "drug-active ingredient-target genedisease" network via using TCMSP, SymMap, GeneCard, and OMIM databases. The PPI network was conducted by the String tool. The core targets of XHW in the treatment of rectal cancer and radiation enteritis were identified by topological analysis, and the functional annotation analysis and pathway enrichment analysis were performed. RESULTS A total of 61 active ingredients of XHW ingredients, 4607 rectal cancer-related genes, 5803 radiation enteritis-related genes, and 68 common targets of XHW in the treatment of rectal cancer and radiation enteritis were obtained. PTGS1 and NR3C2, as identified potential targets, were significantly associated with OS of colorectal cancer patients. GO and KEGG enrichment analysis showed that bioinformatics annotation of these common genes was mainly involved in DNA-binding transcription factor, PI3K/Akt, TNF, HIF-1 signaling pathway, and colorectal cancer pathway. CONCLUSION The active ingredients of XHW, mainly including Quercetin, Ellagic acid, and Stigmasterol, might act on common targets of rectal cancer and radiation enteritis, such as PTGS1, NR3C2, IL-6, EGFR, HIF-1A, CASP3, BCL2, ESR1, MYC, and PPARG, and regulate multiple signaling pathways like PI3K-Akt, TNF, and HIF-1 to inhibit tumor proliferation, tumor angiogenesis, inflammatory responses, and oxidative stress, thereby achieving prevention and treatment of radiation enteritis in rectal cancer patients during radiotherapy. It provided an important reference for further elucidating the anti-inflammation and anti-tumor mechanism and clinical application of XHW.
Collapse
Affiliation(s)
- Minghe Lv
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Rong Ding
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
- Department of Oncology, Chinese Medicine Hospital of Wujin, Changzhou 213100, China
| | - Peizhen Ma
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Yue Feng
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Su Zeng
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Yang Zhang
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Wenhao Shen
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Wenhui Guan
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - E Xiangyu
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Hongwei Zeng
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| | - Jingping Yu
- Department of Radiotherapy, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Zhang Heng Road, Pudong New Area, Shanghai 201203, China
| |
Collapse
|
31
|
Janczak J, Ukegjini K, Bischofberger S, Turina M, Müller PC, Steffen T. Quality of Surgical Outcome Reporting in Randomised Clinical Trials of Multimodal Rectal Cancer Treatment: A Systematic Review. Cancers (Basel) 2023; 16:26. [PMID: 38201454 PMCID: PMC10778098 DOI: 10.3390/cancers16010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs) continue to provide the best evidence for treatment options, but the quality of reporting in RCTs and the completeness rate of reporting of surgical outcomes and complication data vary widely. The aim of this study was to measure the quality of reporting of the surgical outcome and complication data in RCTs of rectal cancer treatment and whether this quality has changed over time. METHODS Eligible articles with the keywords ("rectal cancer" OR "rectal carcinoma") AND ("radiation" OR "radiotherapy") that were RCTs and published in the English, German, Polish, or Italian language were identified by reviewing all abstracts published from 1982 through 2022. Two authors independently screened and analysed all studies. The quality of the surgical outcome and complication data was assessed based on fourteen criteria, and the quality of RCTs was evaluated based on a modified Jadad scale. The primary outcome was the quality of reporting in RCTs and the completeness rate of reporting of surgical results and complication data. RESULTS A total of 340 articles reporting multimodal therapy outcomes for 143,576 rectal cancer patients were analysed. A total of 7 articles (2%) met all 14 reporting criteria, 13 met 13 criteria, 27 met from 11 to 12 criteria, 36 met from 9 to 10 criteria, 76 met from 7 to 8 criteria, and most articles met fewer than 7 criteria (mean 5.5 criteria). Commonly underreported criteria included complication severity (15% of articles), macroscopic integrity of mesorectal excision (17% of articles), length of stay (18% of articles), number of lymph nodes (21% of articles), distance between the tumour and circumferential resection margin (CRM) (26% of articles), surgical radicality according to the site of the primary tumour (R0 vs. R1 + R2) (29% of articles), and CRM status (38% of articles). CONCLUSION Inconsistent surgical outcome and complication data reporting in multimodal rectal cancer treatment RCTs is standard. Standardised reporting of clinical and oncological outcomes should be established to facilitate comparing studies and results of related research topics.
Collapse
Affiliation(s)
- Joanna Janczak
- Clinic for General and Visceral Surgery, Hospital for the Region Fürstenland Toggenburg, CH-9500 Wil, Switzerland;
| | - Kristjan Ukegjini
- Department of Surgery, Hospital of the Canton of St. Gallen, CH-9007 St. Gallen, Switzerland; (K.U.); (S.B.)
| | - Stephan Bischofberger
- Department of Surgery, Hospital of the Canton of St. Gallen, CH-9007 St. Gallen, Switzerland; (K.U.); (S.B.)
| | - Matthias Turina
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091 Zurich, Switzerland;
| | - Philip C. Müller
- Department of Surgery, Clarunis—University Centre for Gastrointestinal and Hepatopancreatobiliary Diseases, CH-4002 Basel, Switzerland;
| | - Thomas Steffen
- Department of Surgery, Hospital of the Canton of St. Gallen, CH-9007 St. Gallen, Switzerland; (K.U.); (S.B.)
| |
Collapse
|
32
|
Yu Z, Hao Y, Huang Y, Ling L, Hu X, Qiao S. Radiotherapy in the preoperative neoadjuvant treatment of locally advanced rectal cancer. Front Oncol 2023; 13:1300535. [PMID: 38074690 PMCID: PMC10704030 DOI: 10.3389/fonc.2023.1300535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/30/2023] [Indexed: 04/04/2024] Open
Abstract
Radiotherapy and chemotherapy are effective treatments for patients with locally advanced rectal cancer (LARC) and can significantly improve the likelihood of R0 resection. Radiotherapy can be used as a local treatment to reduce the size of the tumor, improve the success rate of surgery and reduce the residual cancer cells after surgery. Early chemotherapy can also downgrade the tumor and eliminate micrometastases throughout the body, reducing the risk of recurrence and metastasis. The advent of neoadjuvant concurrent radiotherapy (nCRT) and total neoadjuvant treatment (TNT) has brought substantial clinical benefits to patients with LARC. Even so, given increasing demand for organ preservation and quality of life and the disease becoming increasingly younger in its incidence profile, there is a need to further explore new neoadjuvant treatment options to further improve tumor remission rates and provide other opportunities for patients to choose watch-and-wait (W&W) strategies that avoid surgery. Targeted drugs and immunologic agents (ICIs) have shown good efficacy in patients with advanced rectal cancer but have not been commonly used in neoadjuvant therapy for patients with LARC. In this paper, we review several aspects of neoadjuvant therapy, including radiation therapy and chemotherapy drugs, immune drugs and targeted drugs used in combination with neoadjuvant therapy, with the aim of providing direction and thoughtful perspectives for LARC clinical treatment and research trials.
Collapse
Affiliation(s)
| | | | | | | | - Xigang Hu
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | | |
Collapse
|
33
|
Wan J, Wu R, Fu M, Shen L, Zhang H, Wang Y, Wang Y, Zhou S, Chen Y, Xia F, Zhang Z. TORCH-R trial protocol: hypofractionated radiotherapy combined with chemotherapy and toripalimab for locally recurrent rectal cancer: a prospective, single-arm, two-cohort, phase II trial. Front Oncol 2023; 13:1304767. [PMID: 38053659 PMCID: PMC10694348 DOI: 10.3389/fonc.2023.1304767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
For patients with locally recurrent rectal cancer (LRRC), the response rate to chemoradiotherapy is 40%-50%. Additionally, only approximately 40%-50% of patients with recurrent rectal cancer are able to undergo R0 resection. Recent studies in locally advanced rectal cancer (LARC) have shown promising synergistic effects when combining immunotherapy (PD-1/PD-L1 antibodies) with neoadjuvant chemoradiotherapy (nCRT). Therefore, incorporating immunotherapy into the treatment regimen for LRRC patients has the potential to further improve response rates and prognosis. To investigate this, the TORCH-R trial was conducted. This prospective, single-arm, two-cohort, phase II trial focuses on the use of hypofractionated radiotherapy, chemotherapy, and immunotherapy in LRRC patients without or with oligometastases. The trial will include two cohorts: cohort A consists of rectal cancer patients who are treatment-naive for local recurrence, and cohort B includes patients with progressive disease after first-line chemotherapy. Cohort A and cohort B patients will receive 25-40 Gy/5 Fx irradiation or 15-30 Gy/5 Fx reirradiation for pelvic recurrence, respectively. Subsequently, they will undergo 18 weeks of chemotherapy, toripalimab, and stereotactic ablative radiotherapy (SABR) for all metastatic lesions between chemoimmunotherapy cycles. Decisions regarding follow-up of complete response (CR), radical surgery, sustained treatment of non-resection, or exiting the trial are made by a multidisciplinary team (MDT). The primary endpoint of this study is the local objective response rate (ORR). The secondary endpoints include the extrapelvic response rate, duration of response, local recurrence R0 resection rate, progression-free survival (PFS), overall survival (OS), and safety and tolerability. Notably, this trial represents the first clinical exploration of inducing hypofractionated radiotherapy, chemotherapy, and immunotherapy in LRRC patients. Clinical trial registration https://clinicaltrials.gov/study/NCT05628038, identifier NCT05628038.
Collapse
Affiliation(s)
- Juefeng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Ruiyan Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Miaomiao Fu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Hui Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Shujuan Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yajie Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| |
Collapse
|
34
|
Chen JT, Zhou YW, Han TR, Wei JL, Qiu M. Perioperative immune checkpoint inhibition for colorectal cancer: recent advances and future directions. Front Immunol 2023; 14:1269341. [PMID: 38022667 PMCID: PMC10679411 DOI: 10.3389/fimmu.2023.1269341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
For colorectal cancer (CRC), surgical resection remains essential for achieving good prognoses. Unfortunately, numerous patients with locally advanced CRC and metastatic CRC failed to meet surgical indications or achieve pathological complete response after surgery. Perioperative therapy has been proven to effectively lower tumor staging and reduce recurrence and metastasis. Immune checkpoint inhibitors (ICIs) have shown unprecedented prolongation of survival time and satisfactory safety in patients with high microsatellite instability/deficient mismatch repair (MSI-H/dMMR), while the therapeutic effect obtained by patients with mismatch repair-proficient or microsatellite stable (pMMR/MSS) was considered minimal. However, recent studies found that certain CRC patients with dMMR/MSI-H presented intrinsic or acquired immune resistance, and pMMR/MSS CRC patients can also achieve better efficacy. Therefore, more predictors are required for screening patients with potential clinical benefits. Since the discovery of synergistic effects between immunotherapy, chemotherapy, and radiotherapy, different immunotherapy-based therapies have been applied to the perioperative therapy of CRC in an increasing number of research. This review comprehensively summarized the past and current progress of different combinations of immunotherapy in perioperative clinical trials for CRC, focusing on the efficacy and safety, and points out the direction for future development.
Collapse
Affiliation(s)
- Jiao-Ting Chen
- Department of Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Wen Zhou
- Department of Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ting-Rui Han
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jun-Lun Wei
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Meng Qiu
- Department of Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
35
|
Melissourgou-Syka L, Gillespie MA, O'Cathail SM, Sansom OJ, Steele CW, Roxburgh CSD. A Review of Scheduling Strategies for Radiotherapy and Immune Checkpoint Inhibition in Locally Advanced Rectal Cancer. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2023; 6:187-197. [PMID: 38143952 PMCID: PMC10734391 DOI: 10.36401/jipo-23-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/07/2023] [Accepted: 07/15/2023] [Indexed: 12/26/2023]
Abstract
Colorectal cancer (CRC) is the third most common malignancy across the globe and, despite advances in treatment strategies, survival rates remain low. Rectal cancer (RC) accounts for most of these cases, and traditional management strategies for advanced disease include total neoadjuvant therapy (TNT) with chemoradiotherapy followed by curative surgery. Unfortunately, approximately 10-15% of patients have no response to treatment or have recurrence at a short interval following radiotherapy. The introduction of immunotherapy in the form of immune checkpoint blockade (ICB) in metastatic colorectal cancer has improved clinical outcomes, yet most patients with RC present with microsatellite stable disease, which lacks the immune-rich microenvironment where ICB is most effective. There is evidence that combining radiotherapy with ICB can unlock the mechanisms that drive resistance in patients; however, the sequencing of these therapies is still debated. This review offers a comprehensive overview of clinical trials and preclinical models that use radiotherapy-immunotherapy combinations in RC in an attempt to extrapolate the ideal sequencing of the two treatment modalities. The results highlight the dearth of evidence to answer the question of whether ICB should be given before, during, or after radiotherapy, yet it is suggested that improving the relevance of our preclinical models will provide a platform with higher translational value and will lead to appropriate clinical trial designs.
Collapse
Affiliation(s)
- Lydia Melissourgou-Syka
- School of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- CRUK Beatson Institute, Glasgow, Scotland
| | | | - Sean M. O'Cathail
- School of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Owen J. Sansom
- School of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- CRUK Beatson Institute, Glasgow, Scotland
| | - Colin W. Steele
- School of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- CRUK Beatson Institute, Glasgow, Scotland
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Campbell S. D. Roxburgh
- School of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| |
Collapse
|
36
|
Gao Y, Wu A. Organ Preservation in MSS Rectal Cancer. Clin Colon Rectal Surg 2023; 36:430-440. [PMID: 37795468 PMCID: PMC10547535 DOI: 10.1055/s-0043-1767710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Rectal cancer is a heterogeneous disease with complex genetic and molecular subtypes. Emerging progress of neoadjuvant therapy has led to increased pathological and clinical complete response (cCR) rates for microsatellite stable (MSS) rectal cancer, which responds poorly to immune checkpoint inhibitor alone. As a result, organ preservation of MSS rectal cancer as an alternative to radical surgery has gradually become a feasible option. For patients with cCR or near-cCR after neoadjuvant treatment, organ preservation can be implemented safely with less morbidity. Patient selection can be done either before the neoadjuvant treatment for higher probability or after with careful assessment for a favorable outcome. Those patients who achieved a good clinical response are managed with nonoperative management, organ preservation surgery, or radiation therapy alone followed by strict surveillance. The oncological outcomes of patients with careful selection and organ preservation seem to be noninferior compared with those of radical surgery, with lower postoperative morbidity. However, more studies should be done to seek better regression of tumor and maximize the possibility of organ preservation in MSS rectal cancer.
Collapse
Affiliation(s)
- Yuye Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Aiwen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| |
Collapse
|
37
|
DiPeri TP, Gong J, Burch M. Total neoadjuvant therapy for locally advanced gastric cancer: too much of a good thing? J Gastrointest Oncol 2023; 14:2287-2289. [PMID: 37969840 PMCID: PMC10643586 DOI: 10.21037/jgo-23-682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Timothy P. DiPeri
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jun Gong
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
38
|
Zhang X, Zeng Y, Li H, Zhuang Q, Tang L, Wu J, Li J. A Modified NAR Scoring Model Incorporating Immune Infiltration Characteristics to Better Predict Long-Term Survival Following Neoadjuvant Radiotherapy in Rectal Cancer. Life (Basel) 2023; 13:2106. [PMID: 38004246 PMCID: PMC10672442 DOI: 10.3390/life13112106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The neoadjuvant rectal (NAR) score has been developed as a prognostic tool for survival in locally advanced rectal cancer (LARC). However, the NAR score only incorporates weighted cT, ypT, and ypN categories. This long-term follow-up study aims to modify a novel prognostic scoring model and identify a short-term endpoint for survival. (2) Methods: The prognostic factors for overall survival (OS) were explored through univariate and multivariate analyses. Based on Cox regression modeling, nomogram plots were constructed. Area under the curve (AUC) and concordance indices were used to evaluate the performance of the nomogram. Receiver operating characteristic (ROC) analysis was conducted to compare the efficiency of the nomogram with other prognostic factors. (3) Results: After a long-term follow-up, the 5-year OS was 67.1%. The mean NAR score was 20.4 ± 16.3. Multivariate analysis indicated that CD8+ T-cell, lymphovascular invasion, and the NAR score were independent predictors of OS. The modified NAR scoring model, incorporating immune infiltration characteristics, exhibited a high C-index of 0.739 for 5-year OS, significantly outperforming any individual factor. Moreover, the predictive value of the nomogram was superior to the AJCC stage and pathological complete regression at 3-year, 5-year, and 10-year time points, respectively. Over time, the model's predictions of long-term survival remained consistent and improved in accuracy. (4) Conclusions: The modified NAR scoring model, incorporating immune infiltration characteristics, demonstrates high accuracy and consistency in predicting OS.
Collapse
Affiliation(s)
| | | | | | | | | | - Junxin Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China; (X.Z.); (Y.Z.); (H.L.); (Q.Z.); (L.T.)
| | - Jinluan Li
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China; (X.Z.); (Y.Z.); (H.L.); (Q.Z.); (L.T.)
| |
Collapse
|
39
|
Hall WA, Li J, You YN, Gollub MJ, Grajo JR, Rosen M, dePrisco G, Yothers G, Dorth JA, Rahma OE, Russell MM, Gross HM, Jacobs SA, Faller BA, George S, Al baghdadi T, Haddock MG, Valicenti R, Hong TS, George TJ. Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma. J Clin Oncol 2023; 41:4643-4651. [PMID: 37478389 PMCID: PMC10564288 DOI: 10.1200/jco.22.02525] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Total neoadjuvant therapy (TNT) is a newly established standard treatment for rectal adenocarcinoma. Current methods to communicate magnitudes of regression during TNT are subjective and imprecise. Magnetic resonance tumor regression grade (MR-TRG) is an existing, but rarely used, regression grading system. Prospective validation of MR-TRG correlation with pathologic response in patients undergoing TNT is lacking. Utility of adding diffusion-weighted imaging to MR-TRG is also unknown. METHODS We conducted a multi-institutional prospective imaging substudy within NRG-GI002 (ClinicalTrials.gov identifier: NCT02921256) examining the ability of MR-based imaging to predict pathologic complete response (pCR) and correlate MR-TRG with the pathologic neoadjuvant response score (NAR). Serial MRIs were needed from 110 patients. Three radiologists independently, then collectively, reviewed each MRI for complete response (mriCR), which was tested for positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity with pCR. MR-TRG was examined for association with the pathologic NAR score. All team members were blinded to pathologic data. RESULTS A total of 121 patients from 71 institutions met criteria: 28% were female (n = 34), 84% White (n = 101), and median age was 55 (24-78 years). Kappa scores for T- and N-stage after TNT were 0.38 and 0.88, reflecting fair agreement and near-perfect agreement, respectively. Calling an mriCR resulted in a kappa score of 0.82 after chemotherapy and 0.56 after TNT reflected near-perfect agreement and moderate agreement, respectively. MR-TRG scores were associated with pCR (P < .01) and NAR (P < .0001), PPV for pCR was 40% (95% CI, 26 to 53), and NPV was 84% (95% CI, 75 to 94). CONCLUSION MRI alone is a poor tool to distinguish pCR in rectal adenocarcinoma undergoing TNT. However, the MR-TRG score presents a now validated method, correlated with pathologic NAR, which can objectively measure regression magnitude during TNT.
Collapse
Affiliation(s)
- William A. Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Jiahe Li
- The University of Pittsburgh, Pittsburgh, PA
| | - Y. Nancy You
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Joseph R. Grajo
- University of Florida, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| | - Mark Rosen
- Imaging and Radiation Oncology Core (IROC) Group, and the University of Pennsylvania, Philadelphia, PA
| | - Greg dePrisco
- Baylor Scott and White Health Baylor University Medical Center at Dallas, Dallas, TX
| | | | - Jennifer A. Dorth
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | | | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | | | - Bryan A. Faller
- Missouri Baptist Medical Center/Heartland NCORP, St Louis, MO
| | - Sagila George
- Stephenson Cancer Center University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tareq Al baghdadi
- Trinity Health Ann Arbor Hospital, Michigan Cancer Research Consortium (NCORP), Ann Arbor, MI
| | | | - Richard Valicenti
- University of California Davis Comprehensive Cancer Center/UC Davis School of Med/UC Davis Health, Sacramento, CA
| | - Theodore S. Hong
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Thomas J. George
- University of Florida, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| |
Collapse
|
40
|
Yue Y, Cheng M, Xi X, Wang Q, Wei M, Zheng B. Can neoadjuvant chemoradiotherapy combined with immunotherapy benefit patients with microsatellite stable locally advanced rectal cancer? a pooled and integration analysis. Front Oncol 2023; 13:1280995. [PMID: 37869097 PMCID: PMC10588447 DOI: 10.3389/fonc.2023.1280995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
Objective To assess the clinical efficacy of neoadjuvant chemoradiotherapy combined with immunotherapy for patients with microsatellite stable (MSS) locally advanced rectal cancer and provide evidence to support clinical decision-making. Methods A systematic search was conducted on the PubMed, Embase, Cochrane Collaboration databases, conference summaries, and Chinese databases for clinical studies that investigated neoadjuvant chemoradiotherapy combined with immunotherapy for the treatment of locally advanced rectal cancer with MSS status. The search spanned from the inception of each database through July 2023. Data from the identified studies were extracted using a pre-designed table, and efficacy outcomes were analyzed. An integrated analysis was conducted using Stata 12.0 software. Results Eight studies were included, comprising 204 patients with locally advanced MSS rectal cancer who received chemoradiotherapy combined with immunotherapy. The integrated analysis revealed a pathologic complete remission rate of 0.33, a sphincter preservation rate of 0.86, an R0 resection rate of 0.83, a major pathologic remission rate of 0.33, and a clinical complete remission rate of 0.30. Conclusion Neoadjuvant chemoradiotherapy combined with immunotherapy demonstrates significant short-term efficacy in MSS-type locally advanced rectal cancer, notably enhancing the pathologic complete remission and sphincter preservation rates. This combination is a recommended treatment for patients with MSS-type rectal cancer.
Collapse
Affiliation(s)
- Yumin Yue
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Min Cheng
- Department of Colorectal Surgery, Xi'an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Xiaohui Xi
- Department of Colorectal Surgery, Xi'an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Quan Wang
- Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| |
Collapse
|
41
|
Grassi E, Zingaretti C, Petracci E, Corbelli J, Papiani G, Banchelli I, Valli I, Frassineti GL, Passardi A, Di Bartolomeo M, Pietrantonio F, Gelsomino F, Carandina I, Banzi M, Martella L, Bonetti AV, Boccaccino A, Molinari C, Marisi G, Ugolini G, Nanni O, Tamberi S. Phase II study of capecitabine-based concomitant chemoradiation followed by durvalumab as a neoadjuvant strategy in locally advanced rectal cancer: the PANDORA trial. ESMO Open 2023; 8:101824. [PMID: 37774508 PMCID: PMC10594026 DOI: 10.1016/j.esmoop.2023.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND This study investigated the efficacy of chemoradiotherapy (CRT) followed by durvalumab as neoadjuvant therapy of locally advanced rectal cancer. PATIENTS AND METHODS The PANDORA trial is a prospective, phase II, open-label, single-arm, multicenter study aimed at evaluating the efficacy and safety of preoperative treatment with durvalumab (1500 mg every 4 weeks for three administrations) following long-course radiotherapy (RT) plus concomitant capecitabine (5040 cGy RT in 25-28 fractions over 5 weeks and capecitabine administered at 825 mg/m2 twice daily). The primary endpoint was the pathological complete response (pCR) rate; secondary endpoints were the proportion of clinical complete remissions and safety. The sample size was estimated assuming a null pCR proportion of 0.15 and an alternative pCR proportion of 0.30 (α = 0.05, power = 0.80). The proposed treatment could be considered promising if ≥13 pCRs were observed in 55 patients (EudraCT: 2018-004758-39; NCT04083365). RESULTS Between November 2019 and August 2021, 60 patients were accrued, of which 55 were assessable for the study's objectives. Two patients experienced disease progression during treatment. Nineteen out of 55 eligible patients achieved a pCR (34.5%, 95% confidence interval 22.2% to 48.6%). Regarding toxicity related to durvalumab, grade 3 adverse events (AEs) occurred in four patients (7.3%) (diarrhea, skin toxicity, transaminase increase, lipase increase, and pancolitis). Grade 4 toxicity was not observed. In 20 patients (36.4%), grade 1-2 AEs related to durvalumab were observed. The most common were endocrine toxicity (hyper/hypothyroidism), dermatologic toxicity (skin rash), and gastrointestinal toxicity (transaminase increase, nausea, diarrhea, constipation). CONCLUSION This study met its primary endpoint showing that CRT followed by durvalumab could increase pCR with a safe toxicity profile. This combination is a promising, feasible strategy worthy of further investigation.
Collapse
Affiliation(s)
- E Grassi
- Medical Oncology Unit, "Degli Infermi" Hospital, AUSL della Romagna, Faenza
| | - C Zingaretti
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - E Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - J Corbelli
- Medical Oncology Unit, "Degli Infermi" Hospital, AUSL della Romagna, Faenza
| | - G Papiani
- Medical Oncology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna
| | - I Banchelli
- Pathology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna
| | - I Valli
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - G L Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - A Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - M Di Bartolomeo
- Gastroenterological Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - F Pietrantonio
- Gastroenterological Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - F Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, Modena
| | - I Carandina
- Department of Medical Oncology, "Sant'Anna" University Hospital of Ferrara, Ferrara
| | - M Banzi
- Medical Oncology Unit, "Santa Maria Nuova" Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia
| | - L Martella
- Department of Medical Oncology, "Sant'Anna" University Hospital of Ferrara, Ferrara
| | - A V Bonetti
- Department of Medical Oncology, "Mater Salutis" Hospital, Legnago
| | - A Boccaccino
- Medical Oncology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna
| | - C Molinari
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - G Marisi
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - G Ugolini
- General Surgery Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna, Italy
| | - O Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - S Tamberi
- Medical Oncology Unit, "Degli Infermi" Hospital, AUSL della Romagna, Faenza; Medical Oncology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna.
| |
Collapse
|
42
|
Veen T, Kanani A, Lea D, Søreide K. Clinical trials of neoadjuvant immune checkpoint inhibitors for early-stage operable colon and rectal cancer. Cancer Immunol Immunother 2023; 72:3135-3147. [PMID: 37528319 PMCID: PMC10491705 DOI: 10.1007/s00262-023-03480-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/08/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have become first-line treatment for metastatic colorectal cancer (CRC) with deficient mismatch repair (dMMR). Despite the remarkable response reported in preliminary trials, the role of ICI in patients with early-stage, operable CRC remains unclear. The aim of this study was to investigate trials on neoadjuvant ICI in operable CRC. MATERIALS AND METHODS Scoping review of clinical trial registries (Clinicaltrials.gov and EU clinical trial registers) and PubMed/Medline database of trials on neoadjuvant ICI for operable CRC was done up to December 2022. RESULTS Some 40 trials investigating neoadjuvant ICI for early-stage, operable CRC were identified, including five published trials and three conference abstracts. Preclinical phase I/II trial predominated with only three clinical phase III trials. Few trials investigated neoadjuvant ICI as the only intervention (monotherapy). Trials in rectal cancer were designed for combined ICI with chemo(radio)therapy, only 8 trials stating an MSI/dMMR status for inclusion, one designed for MSS/pMMR only and, the rest agnostic for MMR status. Thirty-eight (95%) trials investigated programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitors. PD-1/PD-L1 inhibitors were combined with vascular endothelial growth factor (VEGF) inhibitor or with cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) inhibitor, in two trials each, respectively. Pathological complete response as primary outcome after surgery was the most frequently used study endpoint. In rectal cancer, six trials included a "watch and wait" strategy for patients with complete clinical response. No "watch and wait" study design for colon cancer after neoadjuvant ICI were identified. CONCLUSION High response rates from neoadjuvant ICI in early-stage colon and rectal cancer are reported in phase I/II studies. Contemporary trial designs are heterogeneous, with few comparable inclusion criteria, use of several drug combinations and durations and, wide variation of endpoints reported. Harmonizing clinical and translational aspects including survival data is needed for improved future trial designs with clinical impact.
Collapse
Affiliation(s)
- Torhild Veen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Gastrointestinal Translational Research Unit, Laboratory for Molecular Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Arezo Kanani
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Gastrointestinal Translational Research Unit, Laboratory for Molecular Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Dordi Lea
- Gastrointestinal Translational Research Unit, Laboratory for Molecular Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
- Gastrointestinal Translational Research Unit, Laboratory for Molecular Medicine, Stavanger University Hospital, Stavanger, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| |
Collapse
|
43
|
Quezada-Diaz FF, Smith JJ. Is Nonoperative Management of Rectal Cancer Feasible? Adv Surg 2023; 57:141-154. [PMID: 37536849 PMCID: PMC10926904 DOI: 10.1016/j.yasu.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
During the past decade, the treatment of locally advanced rectal cancer (LARC) has become more complex. Total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathologic complete response, resulting in improved long-term oncological outcomes. The feasibility to implement nonoperative management (NOM) depends on solving current challenges such as how to correctly identify the best candidates for a NOM without compromising oncologic safety. NOM should be part of the treatment discussion of LARC, considering increasing rates of clinical complete response, potential quality of life gains, avoidance of surgical morbidity, and patient preferences.
Collapse
Affiliation(s)
- Felipe F Quezada-Diaz
- Colorectal Unit, Department of Surgery, Complejo Asistencial Doctor Sótero del Río, Santiago, Región Metropolitana, Chile. https://twitter.com/ffquezad
| | - Jesse Joshua Smith
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue | SR-201, New York, NY 10065, USA.
| |
Collapse
|
44
|
McMahon RK, O'Cathail SM, Nair H, Steele CW, Platt JJ, Digby M, McDonald AC, Horgan PG, Roxburgh CSD. The neoadjuvant rectal score and a novel magnetic resonance imaging based neoadjuvant rectal score are stage independent predictors of long-term outcome in locally advanced rectal cancer. Colorectal Dis 2023; 25:1783-1794. [PMID: 37485654 DOI: 10.1111/codi.16667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/24/2023] [Accepted: 06/25/2023] [Indexed: 07/25/2023]
Abstract
AIM Neoadjuvant rectal (NAR) score is an early surrogate for longer-term outcomes in rectal cancer undergoing radiotherapy and resection. In an era of increasing organ preservation, resection specimens are not always available to calculate the NAR score. Post-treatment magnetic resonance imaging (MRI) re-staging of regression is subjective, limiting reproducibility. We explored the potential for a novel MRI-based NAR score (mrNAR) adapted from the NAR formula. METHODS Locally advanced rectal cancer patients undergoing neoadjuvant therapy (nCRT) and surgery were retrospectively identified between 2008 and 2020 in a single cancer network. mrNAR was calculated by adapting the NAR formula, replacing pathological (p) stages with post-nCRT MR stages (ymr). Cox regression assessed relationships between clinicopathological characteristics, NAR and mrNAR with overall survival (OS) and recurrence-free survival (RFS). RESULTS In total, 381 NAR and 177 mrNAR scores were calculated. On univariate analysis NAR related to OS (hazard ratio [HR] 2.05, 95% confidence interval [CI] 1.33-3.14, p = 0.001) and RFS (HR 2.52, 95% CI 1.77-3.59, p = 0.001). NAR 3-year OS <8 was 95.3%, 8-16 was 88.6% and >16 was 80%. mrNAR related to OS (HR 2.96, 95% CI 1.38-6.34, p = 0.005) and RFS (HR 2.99, 95% CI 1.49-6.00, p = 0.002). 3-year OS for mrNAR <8 was 96.2%, 8-16 was 92.4% and >16 was 78%. On multivariate analysis, mrNAR was a stage-independent predictor of OS and RFS. mrNAR corresponded to NAR score category in only 15% (positive predictive value 0.23) and 47.5% (positive predictive value 0.48) of cases for categories <8 and >16, respectively. CONCLUSIONS Neoadjuvant rectal score is validated as a surrogate end-point for long-term outcomes. mrNAR categories do not correlate with NAR but have stage-independent prognostic value. mrNAR may represent a novel surrogate end-point for future neoadjuvant treatments that focus on organ preservation.
Collapse
Affiliation(s)
- Ross K McMahon
- Academic Unit of Surgery, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sean M O'Cathail
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Harikrishnan Nair
- Academic Unit of Surgery, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Colin W Steele
- Academic Unit of Surgery, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jonathan J Platt
- Radiology/Imaging Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Michael Digby
- Radiology/Imaging Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Alec C McDonald
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Campbell S D Roxburgh
- Academic Unit of Surgery, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
45
|
Li F, Zhang C, Xu L, Zhang S, Zhang D, Leng Y, Wu C, Chen J, Sun X. Neoadjuvant chemoradiotherapy with capecitabine based regimen in locally advanced rectal cancer: A retrospective study. Medicine (Baltimore) 2023; 102:e34985. [PMID: 37653735 PMCID: PMC10470674 DOI: 10.1097/md.0000000000034985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Capecitabine-based neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for locally advanced rectal cancer. The objective of this study is to analyze overall survival (OS), disease-free survival (DFS) and prognostic factors of patients with stage II to III rectal cancer treated with nCRT in our institution. Between March 2014 to June 2020, 121 locally advanced rectal cancer patients were retrospectively reviewed and analyzed. All of the enrolled patients were treated with capecitabine-based nCRT (pelvic radiotherapy: 45-50.4 Gy, 1.8 Gy/d plus concomitant capecitabine-based chemotherapy), total mesorectal excision surgery (surgery was carried out 8-12 weeks after the end of CRT), and capecitabine-based adjuvant chemotherapy. We examined the pathological complete response rate, 3-year OS, 3-year DFS and the other prognostic factors. Kaplan-Meier method and Log-rank test were used to estimate and compare survival rate. With a median follow-up of 36 months, 3-year DFS and 3-year OS was 74.4% and 83.2%, respectively. Among the 121 patients, 24 achieved pathological complete remission (19.8%). After multivariate analysis, ypTNM stage (TNM stage after neoadjuvant therapy) was significantly associated with DFS. Positive mesorectal fasciae (MRF) status on magnetic resonance imaging and ypTNM stage were significantly related to OS. CRT with capecitabine based regimen provides high rates of survival and sphincter preservation with acceptable toxicity. YpTNM stage was significantly associated with DFS; magnetic resonance imaging MRF status and ypTNM stage were significant factors for OS after multivariate analysis. Distant metastasis is the dominant mode of treatment failure, and it is crucial to optimize systemic treatment for newly diagnosed patients.
Collapse
Affiliation(s)
- Fei Li
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liping Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sheng Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongsheng Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Leng
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chenjiang Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiayan Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
46
|
Han Q, Zeng H, Xu W, Wu M. Neoadjuvant anti-PD-1/PD-L1 therapy for colorectal cancer: Current status and future prospects. Shijie Huaren Xiaohua Zazhi 2023; 31:615-621. [DOI: 10.11569/wcjd.v31.i15.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023] Open
Abstract
Immunotherapy, particularly programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors, has made revolutionary progress in the treatment strategies for various types of cancer. Regarding colorectal cancer (CRC), the current clinical application of PD-1/PD-L1 inhibitors is primarily categorized based on mutation patterns, including deficient mismatch repair (dMMR)/high microsatellite instability (MSI-H) and proficient mismatch repair (pMMR) or non-high microsatellite instability (non-MSI-H). PD-1/PD-L1 inhibitors have demonstrated good efficacy against dMMR/MSI-H CRC by increasing T-cell infiltration into tumor tissues. However, the effectiveness of PD-1/PD-L1 inhibitors for pMMR/non-MSI-H CRC remains uncertain. Due to the lower prevalence of dMMR/MSI-H in CRC, recent clinical trials have reported combined applications of PD-1/PD-L1 inhibitors with other anti-tumor treatments such as chemotherapy, radiotherapy, and targeted therapy to achieve better therapeutic outcomes. Neoadjuvant therapy, primarily consisting of chemotherapy and radiotherapy, not only downstages the tumor but also provides benefits from local control, thus improving clinical symptoms and quality of life. Integrating immunotherapy into neoadjuvant therapy may alter the treatment approach for potentially resectable or certain metastatic CRC cases. In this article, we focus on the development of neoadjuvant anti-PD-1/PD-L1 therapy and discuss its future prospects for the treatment of CRC.
Collapse
Affiliation(s)
- Qu Han
- First Department of General Surgery, Fengcheng City People's Hospital, Fengcheng 331100, Jiangxi Province, China
| | - Hui Zeng
- First Department of General Surgery, Fengcheng City People's Hospital, Fengcheng 331100, Jiangxi Province, China
| | - Wei Xu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Mo Wu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| |
Collapse
|
47
|
Ozer M, Vegivinti CTR, Syed M, Ferrell ME, Gonzalez Gomez C, Cheng S, Holder-Murray J, Bruno T, Saeed A, Sahin IH. Neoadjuvant Immunotherapy for Patients with dMMR/MSI-High Gastrointestinal Cancers: A Changing Paradigm. Cancers (Basel) 2023; 15:3833. [PMID: 37568648 PMCID: PMC10417711 DOI: 10.3390/cancers15153833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Immune checkpoint inhibitors have revolutionized the management of mismatch repair-deficient (MMR-D)/microsatellite instability-high (MSI-H) gastrointestinal cancers, particularly colorectal cancer. Cancers with the MMR-D/MSI-H genotype often carry a higher tumor mutation burden with frameshift alterations, leading to increased mutation-associated neoantigen (MANA) generation. The dramatic response seen with immune checkpoint inhibitors (ICIs), which are orchestrated by MANA-primed effector T cells, resulted in the rapid development of these novel therapeutics within the landscape of MSI-H gastrointestinal cancers. Recently, several clinical trials have utilized ICIs as potential neoadjuvant therapies for MSI-H gastrointestinal cancers and demonstrated deep clinical and pathological responses, creating opportunities for organ preservation. However, there are potential challenges to the neoadjuvant use of ICIs for certain disease types due to the clinical risk of overtreatment for a disease that can be cured through a surgery-only approach. In this review article, we discuss neoadjuvant management approaches with ICI therapy for patients with MSI-H gastrointestinal cancers, including those with oligometastatic disease. We also elaborate on potential challenges and opportunities for the neoadjuvant utilization of ICIs and provide further insight into the changing treatment paradigm of MMR-D/MSI-H gastrointestinal cancers.
Collapse
Affiliation(s)
- Muhammet Ozer
- Department of Gastrointestinal Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | | | - Masood Syed
- Department of Medicine, University of Pittsburg School of Medicine, Pittsburgh, PA 15213, USA
| | - Morgan E. Ferrell
- Department of Medicine, University of Pittsburg School of Medicine, Pittsburgh, PA 15213, USA
| | - Cyndi Gonzalez Gomez
- Department of Medicine, University of Pittsburg School of Medicine, Pittsburgh, PA 15213, USA
| | - Svea Cheng
- Department of Medicine, University of Pittsburg School of Medicine, Pittsburgh, PA 15213, USA
| | - Jennifer Holder-Murray
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Tullia Bruno
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Anwaar Saeed
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ibrahim Halil Sahin
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| |
Collapse
|
48
|
Schrag D, Shi Q, Weiser MR, Gollub MJ, Saltz LB, Musher BL, Goldberg J, Al Baghdadi T, Goodman KA, McWilliams RR, Farma JM, George TJ, Kennecke HF, Shergill A, Montemurro M, Nelson GD, Colgrove B, Gordon V, Venook AP, O'Reilly EM, Meyerhardt JA, Dueck AC, Basch E, Chang GJ, Mamon HJ. Preoperative Treatment of Locally Advanced Rectal Cancer. N Engl J Med 2023; 389:322-334. [PMID: 37272534 PMCID: PMC10775881 DOI: 10.1056/nejmoa2303269] [Citation(s) in RCA: 142] [Impact Index Per Article: 142.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Pelvic radiation plus sensitizing chemotherapy with a fluoropyrimidine (chemoradiotherapy) before surgery is standard care for locally advanced rectal cancer in North America. Whether neoadjuvant chemotherapy with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) can be used in lieu of chemoradiotherapy is uncertain. METHODS We conducted a multicenter, unblinded, noninferiority, randomized trial of neoadjuvant FOLFOX (with chemoradiotherapy given only if the primary tumor decreased in size by <20% or if FOLFOX was discontinued because of side effects) as compared with chemoradiotherapy. Adults with rectal cancer that had been clinically staged as T2 node-positive, T3 node-negative, or T3 node-positive who were candidates for sphincter-sparing surgery were eligible to participate. The primary end point was disease-free survival. Noninferiority would be claimed if the upper limit of the two-sided 90.2% confidence interval of the hazard ratio for disease recurrence or death did not exceed 1.29. Secondary end points included overall survival, local recurrence (in a time-to-event analysis), complete pathological resection, complete response, and toxic effects. RESULTS From June 2012 through December 2018, a total of 1194 patients underwent randomization and 1128 started treatment; among those who started treatment, 585 were in the FOLFOX group and 543 in the chemoradiotherapy group. At a median follow-up of 58 months, FOLFOX was noninferior to chemoradiotherapy for disease-free survival (hazard ratio for disease recurrence or death, 0.92; 90.2% confidence interval [CI], 0.74 to 1.14; P = 0.005 for noninferiority). Five-year disease-free survival was 80.8% (95% CI, 77.9 to 83.7) in the FOLFOX group and 78.6% (95% CI, 75.4 to 81.8) in the chemoradiotherapy group. The groups were similar with respect to overall survival (hazard ratio for death, 1.04; 95% CI, 0.74 to 1.44) and local recurrence (hazard ratio, 1.18; 95% CI, 0.44 to 3.16). In the FOLFOX group, 53 patients (9.1%) received preoperative chemoradiotherapy and 8 (1.4%) received postoperative chemoradiotherapy. CONCLUSIONS In patients with locally advanced rectal cancer who were eligible for sphincter-sparing surgery, preoperative FOLFOX was noninferior to preoperative chemoradiotherapy with respect to disease-free survival. (Funded by the National Cancer Institute; PROSPECT ClinicalTrials.gov number, NCT01515787.).
Collapse
Affiliation(s)
- Deborah Schrag
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Qian Shi
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Martin R Weiser
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Marc J Gollub
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Leonard B Saltz
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Benjamin L Musher
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Joel Goldberg
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Tareq Al Baghdadi
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Karyn A Goodman
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Robert R McWilliams
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Jeffrey M Farma
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Thomas J George
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Hagen F Kennecke
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Ardaman Shergill
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Michael Montemurro
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Garth D Nelson
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Brian Colgrove
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Vallerie Gordon
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Alan P Venook
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Eileen M O'Reilly
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Jeffrey A Meyerhardt
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Amylou C Dueck
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Ethan Basch
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - George J Chang
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| | - Harvey J Mamon
- From the Departments of Medicine (D.S., L.B.S., E.M.O.), Surgery (M.R.W.), and Radiology (M.J.G.), Memorial Sloan Kettering Cancer Center, and the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai (K.A.G.) - both in New York; Alliance Statistics and Data Management Center (Q.S., G.D.N., B.C., A.C.D.) and the Department of Oncology (R.R.M.), Mayo Clinic, Rochester, MN; SWOG Cancer Research Network and the Department of Medicine, Baylor College of Medicine (B.L.M.), and the Department of Colon and Rectal Surgery, M.D. Anderson Cancer Center (G.J.C.) - both in Houston; the Departments of Surgery (J.G.) and Radiation Oncology (H.J.M.), Brigham and Women's Hospital, and the Department of Medical Oncology, Dana-Farber Cancer Institute (J.A.M.) - both in Boston; IHA Hematology Oncology, Ypsilanti, MI (T.A.B.); ECOG-ACRIN Cancer Research Network and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia (J.M.F.); NRG Oncology and the University of Florida Health Cancer Center, Gainesville (T.J.G.); Canadian Cancer Trials Group, Kingston, ON (H.F.K.), and the Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg (V.G.) - both in Canada; Alliance Protocol Office, Chicago (A.S.); the Swiss Group for Clinical Cancer Research, Bern, Switzerland (M.M.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco (A.P.V.); and the Department of Medical Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill (E.B.)
| |
Collapse
|
49
|
Wang CX, Hunt J, Feinstein S, Kim SK, Monjazeb AM. Advances in Radiotherapy Immune Modulation: From Bench-to-Bedside and Back Again. Surg Oncol Clin N Am 2023; 32:617-629. [PMID: 37182996 DOI: 10.1016/j.soc.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Pre-clinical and clinical data clearly demonstrate the immune modulatory effects of radiotherapy (RT) but clinical trials testing RT + immunotherapy have been equivocal. An improved understanding of the immune modulatory effects of RT and how practical parameters of RT delivery (site and number of lesions, dose, fractionation, timing) influence these effects are needed to optimally combine RT with immunotherapy. Additionally, increased exploration of immunotherapy combinations with RT, beyond immune checkpoint inhibitors, are needed. A "bench-to-bedside and back again" approach will improve our understanding of RT immune modulation and allow for the implementation of more effective RT + immunotherapy strategies.
Collapse
Affiliation(s)
- Charles X Wang
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Jared Hunt
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Shera Feinstein
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Soo Kyoung Kim
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Arta M Monjazeb
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA.
| |
Collapse
|
50
|
Saúde-Conde R, Nguyen D, Hendlisz A. Immunotherapies in non-metastatic gastrointestinal cancers. Curr Opin Oncol 2023; 35:334-346. [PMID: 37222204 DOI: 10.1097/cco.0000000000000956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Over the last decade, immune checkpoint inhibitors (ICI) have emerged as cornerstone in the treatment of many metastatic tumour types, including gastrointestinal cancers. In many solid tumours, the effective therapies in the metastatic field are progressively brought into the curative setting. Consequently, earlier tumoural settings have become a field of experiment for immunotherapies. In melanoma, lung, and bladder cancers, excellent results were recorded, possibly explained by differences in the tumour microenvironment between metastatic and non-metastatic settings. In gastrointestinal (GI) Oncology, nivolumab is the first immune checkpoint inhibitor to become a standard-of-care adjuvant treatment after curative surgery for oesophagal or gastroesophageal junction cancer. RECENT FINDINGS We herein discuss the results of a selection of the most relevant studies presented/published over the last 18 months testing immunotherapies in non-metastatic GI cancers. Among immunotherapies, ICI have been investigated in pre-, peri- and postoperative setting across tumour types, alone or in combination with chemo- and/or radiotherapy. Vaccines are also a new field of investigation. SUMMARY Promising results from two studies (NCT04165772 and NICHE-2 study) demonstrating never-seen-before responses to neoadjuvant immunotherapy in MMR deficient (dMMR) colorectal cancers raise hope for improving the patients' outcome and developing organ-sparing strategies in this situation.
Collapse
Affiliation(s)
| | - Dan Nguyen
- Department of Medical Oncology, Institut Jules Bordet, The Brussels University Hospital (HUB)
| | - Alain Hendlisz
- Department of Digestive Oncology
- Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|