Xiao Binyi, Yu Jiehai, Ding Pei-Rong
Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.
Clin Colon Rectal Surg. 2023 Apr 9;36(6):378-384. doi: 10.1055/s-0043-1767703. eCollection 2023 Nov.
Immunotherapy with PD-1 blockade has achieved a great success in colorectal cancers (CRCs) with high microsatellite instability (MSI-H) and deficient mismatch repair (dMMR), and has become the first-line therapy in metastatic setting. Studies of neoadjuvant immunotherapy also report exciting results, showing high rates of clinical complete response (cCR) and pathological complete response. The high efficacy and long duration of response of immunotherapy has prompt attempts to adopt watch-and-wait strategy for patients achieving cCR following the treatment. Thankfully, the watch-and-wait approach has been proposed for nearly 20 years for patients undergoing chemoradiotherapy and has gained ground among patients as well as clinicians. In this narrative review, we combed through the available information on immunotherapy for CRC and on the watch-and-wait strategy in chemoradiotherapy, and looked forward to a future where neoadjuvant immunotherapy as a curative therapy would play a big part in the treatment of MSI-H/dMMR CRC.
在微卫星高度不稳定（MSI-H）和错配修复缺陷（dMMR）的结直肠癌（CRC）中，使用程序性死亡受体1（PD-1）阻断剂的免疫疗法取得了巨大成功，并已成为转移性结直肠癌的一线治疗方法。新辅助免疫疗法的研究也报告了令人振奋的结果，显示出较高的临床完全缓解（cCR）率和病理完全缓解率。免疫疗法的高效性和长期缓解效果促使人们尝试对治疗后达到cCR的患者采取观察等待策略。值得庆幸的是，观察等待方法已针对接受放化疗的患者提出了近20年，并在患者和临床医生中得到了认可。在这篇叙述性综述中，我们梳理了关于结直肠癌免疫疗法和放化疗观察等待策略的现有信息，并展望了新辅助免疫疗法作为一种治愈性疗法在MSI-H/dMMR结直肠癌治疗中发挥重要作用的未来。
