ESMO Newsflash: 95% of patients have complete pathological remission, and an anti-heavenly treatment plan is about to appear?

With the improvement of living standards, the incidence of bowel cancer is gradually increasing due to the influence of eating habits
.

About 10%-15% of all colorectal cancer patients have microsatellite height instability (dMMR
).

For patients with this type of bowel cancer, immunotherapy will be more
effective.

At present, surgical treatment is still the first choice
for patients with early-stage colorectal cancer.

With the development of neoadjuvant therapy, neoadjuvant therapy
is performed preoperatively to reduce the risk of postoperative recurrence, depending on the patient's condition.

However, recent data show that when coloral cancer patients with microsatellite high instability use neoadjuvant chemotherapy, the proportion of patients who can achieve pathological response is low, accounting for only 5%-7%, and if it is stage III bowel cancer patients, 20%-40% of patients will have a recurrence
.

Finally, this impasse was broken, and immunotherapy drugs were used for neoadjuvant therapy
.

What effect will the PD-1 inhibitor navuriumab and the CTLA-4 inhibitor icimumab have when these two drugs are combined? This is the latest research
report from the 2022 European Oncology Annual Conference.

With only two cycles of treatment, 99% of patients responded

This is a clinical study conducted at the Netherlands Cancer Institute (NICHE-2) that included 112 patients, of whom 58% were women, with a median age of 60 years
.

Patients were diagnosed with non-metastatic colorectal cancer, 74% of patients are clinical stage III, and the detection indicators show that they have microsatellite high instability (MMR
).

These patients received two courses of treatment before surgery
.

The first course of treatment is the CTLA-4 inhibitor ipimumab combined with the PD-1 inhibitor navulluzumab
.

The dose of ipimuzumab is 1 mg per kilogram of body weight and the dose of navurizumab is 3 mg
per kilogram of body weight.

The second course of treatment uses only the PD-1 inhibitor navurizumab
.

All patients undergo surgery after six weeks
.

The primary endpoints of the study were safety and three-year disease-free survival (DFS
).

The primary pathological remission rate and the complete pathological remission rate were the secondary study endpoints
.

In terms of safety, only 13% of patients experienced immunorelated adverse events of more than three grades
.

2% of patients experienced adverse events that delayed surgery by more than two weeks, but there were no cases of relapse and no new safety signs
were found.

Figure 1.
98% of patients completed the surgery on time

A complete pathological reaction is when no living tumor cells
are found in the tumor tissue and lymph nodes after surgery.

If a surviving tumor cell is found, but the proportion of tumor cells is less than 10%, it is a major pathological reaction
.

99% of patients have pathological reactions, 95% of the main pathological reactions, and 67%
of the total pathological reactions.

Figure 2.
95% of patients have surgical lesions that achieve a major pathological reaction

A revolutionary breakthrough that changed the pattern of early bowel cancer treatment

Such excellent treatment data will completely change the treatment pattern
of early bowel cancer.

For bowel cancer patients who are about to undergo surgical treatment, genetic testing determines that there is a high degree of instability in microsatellites, and it is possible to immediately undergo two neoadjuvant treatments and then surgically resect, which can almost be close to clinical cure.

Figure 3.
Neoadjuvant therapy of immunological drugs to achieve miraculous results

In addition, the researchers put forward a new idea based on this study: Is surgery still necessary for bowel cancer patients with high degree of instability in microsatellites, if complete remission can be achieved by neoadjuvant therapy, or 95% of the main pathological remission? Can organs be preserved? Will this bring a better quality of life to these bowel cancer patients?

If there is concern that not surgically removing the lesion will increase the risk of recurrence, consider the detection of circulating tumor DNA, as well as new imaging techniques to focus on re-examination
.

Exemption from surgery is important
for older bowel cancer patients.

For microsatellite-stabilized bowel cancer patients, can we use assistive medication or other methods to allow this part of the more intestinal cancer patients to enjoy the benefits of immunotherapy? We look forward to relevant clinical studies
.

Regarding the research reports in this regard, we will interpret and analyze
them for everyone in a timely manner.

Every day when cancer is not completely overcome, cancer is with you to spend it!

References:

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