Introduction: Immune checkpoint inhibitors have revolutionized the treatment of dMMR/MSI-H rectal cancer, but most patients worldwide continue to receive total neoadjuvant therapy (TNT) as standard care. This international real-world study evaluated whether mismatch repair (MMR) or microsatellite (MS) status influences outcomes in patients treated with TNT.
Introduction:
Immune checkpoint inhibitors have revolutionized the treatment of dMMR/MSI-H rectal cancer, but most patients worldwide continue to receive total neoadjuvant therapy (TNT) as standard care. This international real-world study evaluated whether mismatch repair (MMR) or microsatellite (MS) status influences outcomes in patients treated with TNT.
Why was this study needed?
Results:
Clinical Impact:
This large international real-world study suggests that dMMR/MSI-H should not be considered a prognostic biomarker for patients receiving conventional TNT. Instead, the findings further support the growing role of immune checkpoint inhibitors as the preferred treatment strategy for localized dMMR/MSI-H rectal cancer whenever appropriate.
Bottom Line:
Mismatch repair deficiency does not predict better outcomes after total neoadjuvant therapy in locally advanced rectal cancer. Given the remarkable responses previously reported with immunotherapy, patients with dMMR/MSI-H rectal cancer should be considered for immunotherapy-based treatment strategies whenever feasible.
Introduction: Immune checkpoint inhibitors (ICIs) are the standard first-line treatment for MSI-H/dMMR metastatic colorectal cancer (mCRC). In the absence of direct head-to-head trials, this reconstructed individual patient data (IPD) analysis compared nivolumab–ipilimumab, nivolumab, and pembrolizumab...
Introduction: Immune checkpoint inhibitors (ICIs) have transformed the treatment of microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) metastatic colorectal cancer (mCRC). While pembrolizumab and nivolumab are established treatment options, recent evidence has raised interest in dual checkpoint...
Introduction: Neuroendocrine liver metastases (NELM) are a major determinant of morbidity and mortality in patients with neuroendocrine neoplasms. Over the past three decades, advances in imaging, systemic therapies, radionuclide treatment, and liver-directed interventions have expanded...
Introduction: Pathological complete response (pCR) following neoadjuvant therapy is considered a favorable prognostic marker in esophageal adenocarcinoma. However, whether patients achieving pCR derive similar long-term benefit regardless of the neoadjuvant regimen remains uncertain. This multicenter...
Introduction: Circulating tumor DNA (ctDNA) has emerged as a promising noninvasive biomarker for monitoring treatment response and residual disease in solid tumors. However, its prognostic value during neoadjuvant chemotherapy (NAC) for localized pancreatic ductal adenocarcinoma...
Introduction: Aspirin is one of the few interventions proven to reduce colorectal and other Lynch syndrome–associated cancers. The earlier CaPP2 trial established 600 mg daily aspirin as an effective chemopreventive strategy, but concerns regarding long-term...
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