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Sahin IH, Zhang J, Saridogan T, Gorantla V, Rhree J, Malhotra M, Thomas R, Hsu D, Saeed A. Neoadjuvant Immune Checkpoint Inhibitor Therapy for Patients With Microsatellite Instability-High Colorectal Cancer: Shedding Light on the Future. JCO Oncol Pract 2023; 19:251-259. [PMID: 36862965 DOI: 10.1200/op.22.00762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment paradigm of mismatch repair-deficient/microsatellite instability-high (MMMR-D/MSI-H) colorectal cancer (CRC). Unique molecular features of MMR-D/MSI-H CRC with frameshift alterations, which result in mutation-associated neoantigen (MANA) generation, create an ideal molecular framework for MANA-driven T-cell priming and antitumor immunity. These biologic characteristics of MMR-D/MSI-H CRC resulted in rapid drug development with ICIs for patients with MMR-D/MSI-H CRC. Observed deep and durable responses with the use of ICIs in advanced-stage disease have stimulated the development of clinical trials with ICIs for patients with early-stage MMR-D/MSI-H CRC. Most recently, neoadjuvant dostarlimab monotherapy for nonoperative management of MMR-D/MSI-H rectal cancer and neoadjuvant NICHE trial with nivolumab and ipilimumab for MMR-D/MSI-H colon cancer resulted in groundbreaking results. Although nonoperative management of patients with MMR-D/MSI-H rectal cancer with ICIs will potentially define our current therapeutic approach, therapeutic goals of neoadjuvant ICI therapy for patients with MMR-D/MSI-H colon cancer may differ given that nonoperative management has not been well established for colon cancer. Herein, we overview recent advancements in ICI-based therapies for patients with early-stage MMR-D/MSI-H colon and rectal cancer and elaborate on the future treatment paradigm of this unique subgroup of CRC.
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Affiliation(s)
- Ibrahim Halil Sahin
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Janie Zhang
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Turcin Saridogan
- Department of Medicine, Hacettepe University of School of Medicine, Ankara, Turkey
| | | | - John Rhree
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Roby Thomas
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Dennis Hsu
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anwaar Saeed
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,University of Pittsburgh Medical Center, Pittsburgh, PA
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