Katy Marshall

GI Oncology Now

In patients with mismatch repair-deficient colorectal cancer, PD-1 blockade has demonstrated positive benefits in both metastatic and neoadjuvant areas.A phase 2 study from Pei-Rong Ding, MD, and colleagues <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00203-1/abstract" target="_blank" rel="noopener">published in The Lancet Oncology</a> investigated the activity and safety of neoadjuvant camrelizumab plus apatinib in patients with untreated mismatch repair-deficient, microsatellite instability-high, or POLE/POLD1-mutated locally advanced colorectal cancer.In the single-arm trial, patients received camrelizumab 200 mg intravenously on the first day of treatment and apatinib 200 mg orally for the first 14 days of treatment every 3 weeks. Treatment continued for either 3 months followed by surgery or 6 months with no surgery.The study&rsquo;s primary end point was the proportion of patients with a pathological or clinical complete response (CR).Of the 53 participants, 24 (54%; 95% CI, 35-68) reached a clinical CR. Twenty-four of those patients underwent a watch-and-wait approach, including 20 with colon cancer and multiple primary colorectal cancer.Fourteen (61%; 95% CI, 39-80) of the 24 (44%) patients who received surgery for primary tumor demonstrated a complete pathological response, while 38 (73%; 95% CI, 59-84) reported a CR.In 20 (38%) patients, grade 3 to 5 treatment-related adverse events (AEs) were reported. The most frequently reported AEs included increased aminotransferase (11%), bowel obstruction (8%), and hypertension (8%). Six (11%) patients reported drug-related serious AEs, and 1 patient died due to treatment-related immune-related hepatitis.Researchers concluded that neoadjuvant camrelizumab plus apatinib demonstrated encouraging antitumor activity among patients with locally advanced mismatch repair-deficient or microsatellite instability-high colorectal cancer.&ldquo;Immune-related [AEs] should be monitored with the utmost vigilance,&rdquo; the investigators wrote. &ldquo;Organ preservation seems promising not only in patients with rectal cancer, but also in those with colon cancer who have a clinical [CR]. Longer follow-up is needed to assess the oncological outcomes of the watch-and-wait approach.&rdquo;

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Neoadjuvant Camrelizumab Plus Apatinib for Mismatch Repair-Deficient Colorectal Cancer

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In patients with mismatch repair-deficient colorectal cancer, PD-1 blockade has demonstrated positive benefits.