"Locally advanced rectal cancer with dMMR/MSI-H may be excused from surgery after neoadjuvant anti-PD-1 monotherapy: a multiple-center, cohort study"

作者全名："Yang, Renfang; Wu, Tao; Yu, Jiehai; Cai, Xinyi; Li, Guoyu; Li, Xiangshu; Huang, Weixin; Zhang, Ya; Wang, Yuqin; Yang, Xudong; Ren, Yongping; Hu, Ruixi; Feng, Qing; Ding, Peirong; Zhang, Xuan; Li, Yunfeng"

作者地址："[Yang, Renfang; Wu, Tao; Cai, Xinyi; Li, Guoyu; Yang, Xudong; Ren, Yongping; Hu, Ruixi; Feng, Qing; Zhang, Xuan; Li, Yunfeng] Kunming Med Univ, Yunnan Canc Hosp, Dept Colorectal Surg, Affiliated Hosp 3, Kunming, Peoples R China; [Yu, Jiehai; Ding, Peirong] Sun Yat Sen Univ Canc Ctr, Collaborat Innovat Ctr Canc Med, Dept Colorectal Surg, State Key Lab Oncol South China, Guangzhou, Peoples R China; [Li, Xiangshu] Chongqing Med Univ, Affiliated Hosp 1, Dept Gastrointestinal Surg, Chongqing, Peoples R China; [Huang, Weixin] Honghe Prefecture Third Peoples Hosp, Honghe Canc Hosp, Dept Gastrointestinal Surg, Gejiu, Peoples R China; [Zhang, Ya] Kunming Med Univ, Yunnan Canc Hosp, Dept Imaging, Affiliated Hosp 3, Kunming, Peoples R China; [Wang, Yuqin] Kunming Med Univ, Yunnan Canc Hosp, Dept Pathol, Affiliated Hosp 3, Kunming, Peoples R China"

通信作者："Zhang, X; Li, YF (通讯作者)，Kunming Med Univ, Yunnan Canc Hosp, Dept Colorectal Surg, Affiliated Hosp 3, Kunming, Peoples R China.; Ding, PR (通讯作者)，Sun Yat Sen Univ Canc Ctr, Collaborat Innovat Ctr Canc Med, Dept Colorectal Surg, State Key Lab Oncol South China, Guangzhou, Peoples R China."

来源：FRONTIERS IN IMMUNOLOGY

ESI学科分类：IMMUNOLOGY

WOS号：WOS:001025702800001

JCR分区：Q1

影响因子：5.7

年份：2023

卷号：14

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：locally advanced rectal cancer; neoadjuvant immunotherapy; programmed cell death protein-1 inhibitor; mismatch repair-deficient; clinical complete response; watch-and-wait strategy

摘要："ObjectiveExamine patients with locally advanced rectal cancer (LARC) with deficient mismatch repair (dMMR) or microsatellite instability-high (MSI-H) who received neoadjuvant immunotherapy (nIT), and compare the outcomes of those who chose a watch-and-wait (WW) approach after achieving clinical complete response (cCR) or near-cCR with those who underwent surgery and were confirmed as pathological complete response (pCR). MethodsLARC patients with dMMR/MSI-H who received nIT were retrospectively examined. The endpoints were 2-year overall survival (OS), 2-year disease-free survival (DFS), local recurrence (LR), and distant metastasis (DM). The efficacy of programmed cell death protein-1 (PD-1) inhibitor, immune-related adverse events (irAEs), surgery-related adverse events (srAEs), and enterostomy were also recorded. ResultsTwenty patients who received a PD-1 inhibitor as initial nIT were examined. Eighteen patients (90%) achieved complete response (CR) after a median of 7 nIT cycles, including 11 with pCR after surgery (pCR group), and 7 chose a WW strategy after evaluation as cCR or near-cCR (WW group). Both groups had median follow-up times of 25.0 months. Neither group had a case of LR or DM, and the 2-year DFS and OS in each group was 100%. The two groups had similar incidences of irAEs (P=0.627). In the pCR group, however, 2 patients (18.2%) had permanent colostomy, 3 (27.3%) had temporary ileostomy, and 2 (18.2%) had srAEs. ConclusionNeoadjuvant PD-1 blockade had high efficacy and led to a high rate of CR in LARC patients with dMMR/MSI-H. A WW strategy appears to be a safe and reliable option for these patients who achieve cCR or near-cCR after nIT."

基金机构：Scientific Research Fund of Yunnan Provincial Education Department [2022J0227]; Joint Special Funds for the Department of Science and Technology of Yunnan Province-Kunming Medical University [202201AY070001-149]

基金资助正文："This study was supported by the Scientific Research Fund of Yunnan Provincial Education Department (2022J0227 to XZ), and the Joint Special Funds for the Department of Science and Technology of Yunnan Province-Kunming Medical University (202201AY070001-149 to XZ)."