Medical Oncology, St Vincent's Hospital Melbourne , Fitzroy, Australia.
Medical Oncology, Monash Medical Centre , Clayton, Australia.
Expert Rev Gastroenterol Hepatol. 2021 Mar;15(3):291-304. doi: 10.1080/17474124.2021.1845141. Epub 2020 Nov 9.
: Colorectal cancer (CRC) is the third most common malignancy worldwide, with recent trends demonstrating increasing incidence amongst younger patients. Despite multiple treatment options, metastatic disease remains incurable. A new therapeutic strategy to harness the host immune system, specifically with immune checkpoint inhibitors, now has reported results from a number of clinical trials. : This review will discuss in detail microsatellite instability (MSI) and other biomarkers for response to immunotherapy, summarize the pivotal clinical trials of immune checkpoint inhibitors in early-stage and metastatic MSI colorectal cancer, explore strategies to induce treatment responses in MSS CRC and highlight the emerging treatments and novel immune-based therapies under investigation. : Immunotherapy is now a standard of care for the proportion of CRC patients with MSI. While overall survival data are still awaited, the promise of profound and durable responses is highly anticipated. The lack of efficacy in MSS CRC is disappointing and strategies to convert these 'cold' tumors are needed. Further elucidation of optimal use of treatment sequences, combinations and novel agents will improve outcomes.
结直肠癌（CRC）是全球第三大常见恶性肿瘤，最近的趋势表明，年轻患者的发病率呈上升趋势。尽管有多种治疗选择，但转移性疾病仍然无法治愈。一种利用宿主免疫系统的新治疗策略，特别是使用免疫检查点抑制剂，目前已经有多项临床试验报告了结果。
本文将详细讨论微卫星不稳定性（MSI）和其他对免疫治疗反应的生物标志物，总结免疫检查点抑制剂在早期和转移性 MSI 结直肠癌中的关键临床试验，探讨在 MSS CRC 中诱导治疗反应的策略，并强调正在研究中的新治疗方法和新型免疫治疗方法。
免疫疗法现在是 MSI 结直肠癌患者的标准治疗方法。虽然仍在等待总生存数据，但人们非常期待能够产生深刻和持久的反应。在 MSS CRC 中缺乏疗效令人失望，需要寻找使这些“冷”肿瘤发生转化的策略。进一步阐明治疗顺序、联合用药和新型药物的最佳使用方法将改善治疗效果。
