Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, ;China.
Front Immunol. 2024 Oct 4;15:1391038. doi: 10.3389/fimmu.2024.1391038. eCollection 2024.
The application of immunotherapy for treating colorectal cancer (CRC) is currently a research hotspot, and neoadjuvant immunotherapy has shown initial success in treating CRC. The watch-and-wait (W&W) approach is often used after achieving a clinical complete response (cCR) following preoperative treatment of low rectal cancer. However, thus far, the W&W approach has not been reported for patients with colon cancer. Here, we report the case of a 64-year-old patient with heterogeneous multigenic CRC who achieved cCR after five sessions of neoadjuvant immunotherapy before surgery. A W&W approach was used to spare the patient from surgery. A 64-year-old male presented with intermittent abdominal pain. A colonoscopy examination detected an irregular cauliflower-like mass near the hepatic flexure of the ascending colon. The biopsy results indicated adenocarcinoma of the ascending colon. The patient was administered pembrolizumab (200 mg, ivgtt, q3w). After one cycle of treatment, the intestinal obstruction symptoms disappeared, and the treatment was continued for additional three sessions. After complete clinical remission of the tumor was confirmed, the W&W approach was adopted. Follow-up CT scans and colonoscopy examinations confirmed no local tumor regeneration or metastasis. Neoadjuvant immunotherapy is effective for patients with DNA mismatch repair gene deficiency and/or microsatellite instability high with a high rate of cCR or pathologic complete response. The W&W approach may also be suitable for patients with colon cancer. The safety and feasibility of watch and wait in patients with colon cancer need to be verified by more clinical data.
免疫疗法在治疗结直肠癌（CRC）中的应用目前是一个研究热点，新辅助免疫疗法在治疗 CRC 方面已初显成效。在低位直肠癌术前治疗达到临床完全缓解（cCR）后，通常采用观察等待（W&W）方法。然而，迄今为止，尚未有报道将 W&W 方法应用于结肠癌患者。在此，我们报告了一例 64 岁的异质性多基因 CRC 患者，该患者在手术前接受了 5 个疗程的新辅助免疫治疗后达到了 cCR。采用 W&W 方法使患者免于手术。一位 64 岁的男性间歇性腹痛就诊。结肠镜检查发现升结肠肝曲附近有不规则的菜花状肿块。活检结果提示升结肠癌。患者接受了派姆单抗（200 mg，静脉滴注，q3w）治疗。治疗一个周期后，肠梗阻症状消失，继续治疗了另外三个周期。在肿瘤完全临床缓解后，采用了 W&W 方法。后续 CT 扫描和结肠镜检查证实无局部肿瘤再生或转移。新辅助免疫疗法对 DNA 错配修复基因缺陷和/或微卫星高度不稳定的患者有效，其 cCR 或病理完全缓解率较高。W&W 方法也可能适用于结肠癌患者。在结肠癌患者中观察等待的安全性和可行性需要更多的临床数据来验证。
