Anti-PD-1-based immunotherapy as curative-intent treatment in dMMR/MSI-H rectal cancer: A multicentre cohort study. (October 2022)

• Record Type: Journal Article
• Authors: Wang, Qiao-Xuan; Xiao, Bin-Yi; Cheng, Yong; Wu, Ai-Wen; Zhang, Tao; Wang, Hui; Zhang, Xuan; Huang, Wei-Xin; Tang, Jing-Hua; Jiang, Wu; Steele, Scott R.; Krishnamurthi, Smitha; Li, Yuan; Cai, Jian; Kong, Ling-Heng; Li, Dan-Dan; Pan, Zhi-Zhong; Zhang, Xiao-Shi; Ding, Pei-Rong
• Is Part Of: European journal of cancer. Volume 174(2022)
• Page Start: 176
• Page End: 184
• Publication Date: 2022-10
• Subjects: Anti-PD-1 immunotherapy -- Curative-intent -- dMMR/MSI-H -- Rectal cancer -- Organ preservation; TME total mesorectal excision -- dMMR/MSI-H DNA mismatch repair-deficient/microsatellite instability-high -- MMR mismatch repair -- ICI immune checkpoint inhibitor -- PD-1 programmed cell death–1 -- CTLA-4 cytotoxic T lymphocyte antigen-4 -- pCR pathological complete response -- cCR clinical complete response -- MRI magnetic resonance imaging -- CT computer tomography -- CEA carcinoembryonic antigen -- DFS disease-free survival -- ORR overall response rate -- pMMR/MSS proficient DNA mismatch repair/microsatellite stable; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.07.016
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: In a portion of patients with DNA mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) rectal cancer, clinical complete response (cCR) could be achieved after anti-programmed cell death protein 1 (anti-PD-1) immunotherapy. However, no data are available concerning the safety of omitting surgery and adopting immunotherapy as a curative-intent treatment for these patients. Methods: We retrospectively collected a series of patients with dMMR/MSI-H rectal adenocarcinoma who had cCR after receiving anti-PD-1 immunotherapy and adopted immunotherapy as curative-intent treatment from six institutions. Survival outcomes were analysed using the Kaplan–Meier method. Results: Nineteen patients were included with a median age of 48 (range 19–63). One patient was diagnosed with stage I disease, four with stage II disease and fourteen with stage III disease. Sixteen patients received anti-PD-1 immunotherapy as the first line of therapy, and eleven patients were treated with single-agent anti-PD-1 antibodies. The median time from the start of treatment to cCR was 3.8 (range 0.7–6.5) months. During a median follow-up of 17.1 (range 3.1–33.5) months since achieving cCR, no local or distant relapse was observed. Two-year local recurrence-free survival, distant metastasis-free survival, disease free-survival and overall survival for the whole cohort were 100%, 100%, 100% and 100%, respectively. Conclusions: For patients with dMMR/MSI-H locally advanced rectal cancer who achieved cCR during anti-PD-1 immunotherapy, adopting immunotherapy as curative-intent treatment might be an alternative option. Longer follow-up and larger cohorts are warranted to verify this innovative treatment approach. Highlights: Anti-PD-1 antibody demonstrates curative efficacy in dMMR/MSI-H rectal cancer. Anti-PD-1 monotherapy might be sufficient at locally advanced stage. The time and cycle needed for patients to reach cCR varied.