Ando Yohei, Sakurai Tsubasa, Ozaki Kosuke, Matsui Shimpei, Mukai Toshiki, Yamaguchi Tomohiro, Akiyoshi Takashi, Nakayama Izuma, Shigematsu Yasuyuki, Oba Atsushi, Chino Akiko, Fukunaga Yosuke
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
Surg Case Rep. 2024 Aug 26;10(1):198. doi: 10.1186/s40792-024-01994-8.
Treating rectal cancer presents challenges due to postoperative complications and reduced quality of life (QOL). Recent evidence supports the watch-and-wait (WW) approach for patients with a clinical complete response (cCR) following preoperative treatment. In this report, we discuss a case of metastatic rectal cancer with deficient mismatch repair (dMMR) treated successfully with pembrolizumab.
A 47-year-old male with dMMR rectal cancer and a single liver metastasis underwent treatment with pembrolizumab as neoadjuvant therapy. After 10 courses, the rectal lesion achieved cCR, prompting the selection of the WW approach. The liver metastasis showed significant shrinkage; however, the presence of a residual tumor was suspected, leading to a metastasectomy. A pathological complete response (pCR) was confirmed via histological examination. During a 24-month follow-up, there was no evidence of tumor regrowth, local recurrence, or distant metastasis.
The WW strategy is increasingly accepted for patients achieving cCR after preoperative treatment. While pCR in dMMR rectal cancer patients treated with immune checkpoint inhibitors (ICIs) has been documented, accurately predicting pCR from imaging remains challenging. This case illustrates that integrating ICI therapy, surgical interventions, and the WW approach can effectively achieve both oncological safety and improved QOL in the treatment of dMMR metastatic rectal cancer.
由于术后并发症和生活质量（QOL）下降，直肠癌的治疗面临挑战。最近的证据支持对术前治疗后达到临床完全缓解（cCR）的患者采用观察等待（WW）方法。在本报告中，我们讨论了一例错配修复缺陷（dMMR）的转移性直肠癌患者，该患者接受帕博利珠单抗治疗成功。
一名47岁男性，患有dMMR直肠癌并伴有单一肝转移，接受帕博利珠单抗作为新辅助治疗。10个疗程后，直肠病变达到cCR，促使选择WW方法。肝转移灶明显缩小；然而，怀疑存在残留肿瘤，因此进行了肝转移灶切除术。经组织学检查证实为病理完全缓解（pCR）。在24个月的随访期间，没有肿瘤复发、局部复发或远处转移的证据。
对于术前治疗后达到cCR的患者，WW策略越来越被接受。虽然免疫检查点抑制剂（ICI）治疗的dMMR直肠癌患者的pCR已有记录，但通过影像学准确预测pCR仍然具有挑战性。该病例表明，在dMMR转移性直肠癌的治疗中，整合ICI治疗、手术干预和WW方法可以有效实现肿瘤学安全性和改善生活质量。
