Cui Hong-Xia, Yang Xiao-Quan, Zhao Guang-Yue, Wang Feng-Jian, Liu Xin
Department of Pharmacy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China.
Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China.
Front Immunol. 2025 May 1;16:1540751. doi: 10.3389/fimmu.2025.1540751. eCollection 2025.
BACKGROUND: Immunotherapy has become the first-line treatment for metastatic mismatch repair deficient (dMMR) colorectal cancer. The efficacy and safety of neoadjuvant immunotherapy for the treatment of non-metastatic dMMR colorectal cancer remain unclear. In this article, we explore the clinical effect and safety of neoadjuvant immunotherapy for non-metastatic dMMR colorectal cancer. METHODS: We collected clinical data from the databases (PubMed, Wanfang Embase, Cochrane Library, and China National Knowledge Infrastructure databases) up to November 2024. The primary outcomes of major pathological response (MPR), pathological complete response (pCR), and other outcomes were analyzed for the final results. The secondary outcomes (pCR rates for the subgroups) were also analyzed. RESULTS: We included 21 articles with 628 non-metastatic dMMR colorectal cancers. A pCR was found in 320/480 (66.6%) patients [effect size (ES): 0.70, 95% CI: 0.66 to 0.74] with the fixed-effects model and little heterogeneity. A MPR was found in 388/452 (85.8%) patients (ES: 0.86, 95% CI: 0.81 to 0.91) with the fixed-effects model and little heterogeneity. In the subgroup analysis, pCR rates were similar in the T1-T3 group and T4a-T4b group in the fixed-effects model with minimal heterogeneity (OR: 0.76, 95% CI: 0.48 to 1.22). The pCR rates were similar in the colon cancer group and rectal cancer group in the fixed-effects model with minimal heterogeneity (OR: 1.41, 95% CI: 0.39 to 5.12). Similar pCR rates were found in the immune monotherapy group and immune therapy plus chemotherapy group (OR: 0.74, 95% CI: 0.26 to 2.10) with the fixed-effects model and little heterogeneity. CONCLUSION: Neoadjuvant immunotherapy achieves high rates of pCR and MPR for non-metastatic dMMR colorectal cancer. For locally advanced T4 stage dMMR colorectal cancer, neoadjuvant immunotherapy can still achieve good pCR rates. Neoadjuvant immune monotherapy can achieve good pCRs rates, avoiding the toxic side effects caused by combined dual immunotherapy and chemo(radio)therapy. Neoadjuvant immunotherapy could be another treatment option for non-metastatic dMMR colorectal cancer. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42024594173.
背景：免疫疗法已成为转移性错配修复缺陷（dMMR）结直肠癌的一线治疗方法。新辅助免疫疗法治疗非转移性dMMR结直肠癌的疗效和安全性尚不清楚。在本文中，我们探讨新辅助免疫疗法治疗非转移性dMMR结直肠癌的临床效果和安全性。 方法：我们收集了截至2024年11月来自数据库（PubMed、万方、Embase、Cochrane图书馆和中国知网数据库）的临床数据。分析主要病理反应（MPR）、病理完全缓解（pCR）等主要结局以得出最终结果。还分析了次要结局（各亚组的pCR率）。 结果：我们纳入了21篇文章，共628例非转移性dMMR结直肠癌。采用固定效应模型且异质性较小，在320/480（66.6%）的患者中发现了pCR [效应量（ES）：0.70，95%置信区间（CI）：0.66至0.74]。采用固定效应模型且异质性较小，在388/452（85.8%）的患者中发现了MPR（ES：0.86，95% CI：0.81至0.91）。在亚组分析中，采用固定效应模型且异质性最小，T1 - T3组和T4a - T4b组的pCR率相似（比值比（OR）：0.76，95% CI：0.48至1.22）。采用固定效应模型且异质性最小，结肠癌组和直肠癌组的pCR率相似（OR：1.41，95% CI：0.39至5.12）。采用固定效应模型且异质性较小，免疫单药治疗组和免疫治疗联合化疗组的pCR率相似（OR：0.74，95% CI：0.26至2.10）。 结论：新辅助免疫疗法在非转移性dMMR结直肠癌中可实现较高的pCR和MPR率。对于局部晚期T4期dMMR结直肠癌，新辅助免疫疗法仍可获得良好的pCR率。新辅助免疫单药治疗可获得良好的pCR率，避免了联合双重免疫治疗和放（化）疗所引起的毒副作用。新辅助免疫疗法可能是非转移性dMMR结直肠癌的另一种治疗选择。 系统评价注册：https://www.crd.york.ac.uk/prospero/，标识符CRD42024594173 。
Trends Cancer. 2024-12
Zotero 插件
