Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2023; 15(2): 222-233
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.222
Efficacy and safety of preoperative immunotherapy in patients with mismatch repair-deficient or microsatellite instability-high gastrointestinal malignancies
Ying-Jie Li, Xin-Zhi Liu, Yun-Feng Yao, Nan Chen, Zhong-Wu Li, Xiao-Yan Zhang, Xin-Feng Lin, Ai-Wen Wu
Ying-Jie Li, Xin-Zhi Liu, Nan Chen, Ai-Wen Wu, Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
Yun-Feng Yao, Gastro-intestinal Ward III, Beijing Cancer Hospital, Beijing 100142, China
Zhong-Wu Li, Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Xiao-Yan Zhang, Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
Xin-Feng Lin, Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
Author contributions: Wu AW contributed to conception and design of the study, draft and final approval of the manuscript; Li YJ contributed to collection of the data, draft the manuscript, study design and statistical analysis; Wu AW, Li YJ, Liu XZ and Yao YF, Li ZW, Zhang XY, Lin XF contributed to quality control of the study especially the surgery part, acquisition of data; All authors approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 82173156; Beijing Hospitals Authority Clinical Medicine Development of Special Funding, No. ZYLX202116.
Institutional review board statement: This study was approved by the ethics committee of Peking University cancer hospital (approval no. 2022YJZ39).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at drwuaw@sina.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Wen Wu, MD, PhD, Academic Editor, Director, Doctor, Professor, Surgeon, Teacher, Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. drwuaw@sina.com
Received: November 29, 2022
Peer-review started: November 29, 2022
First decision: December 27, 2022
Revised: January 8, 2023
Accepted: February 1, 2023
Article in press: February 1, 2023
Published online: February 27, 2023
Abstract
BACKGROUND

Programmed death protein (PD)-1 blockade immunotherapy significantly prolongs survival in patients with metastatic mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) gastrointestinal malignancies such gastric and colorectal cancer. However, the data on preoperative immunotherapy are limited.

AIM

To evaluate the short-term efficacy and toxicity of preoperative PD-1 blockade immunotherapy.

METHODS

In this retrospective study, we enrolled 36 patients with dMMR/MSI-H gastrointestinal malignancies. All the patients received PD-1 blockade with or without chemotherapy of CapOx regime preoperatively. PD1 blockade 200 mg was given intravenously over 30 min on day 1 of each 21-d cycle.

RESULTS

Three patients with locally advanced gastric cancer achieved pathological complete response (pCR). Three patients with locally advanced duodenal carcinoma achieved clinical complete response (cCR), followed by watch and wait. Eight of 16 patients with locally advanced colon cancer achieved pCR. All four patients with liver metastasis from colon cancer reached CR, including three with pCR and one with cCR. pCR was achieved in two of five patients with non-liver metastatic colorectal cancer. CR was achieved in four of five patients with low rectal cancer, including three with cCR and one with pCR. cCR was achieved in seven of 36 cases, among which, six were selected for watch and wait strategy. No cCR was observed in gastric or colon cancer.

CONCLUSION

Preoperative PD-1 blockade immunotherapy in dMMR/MSI-H gastrointestinal malignancies can achieve a high CR, especially in patients with duodenal or low rectal cancer, and can achieve high organ function protection.

Keywords: Preoperative, PD-1 blockade, dMMR/MSI-H, Gastrointestinal malignancies

Core Tip: To the best of our knowledge, this retrospective study is one of the few to summarize mismatch repair-deficient/microsatellite instability-high gastric, duodenal, and colorectal cancers for preoperative immunotherapy. The cohort was a sequential case analysis that only one patient was excluded from the cohort because symptoms disappeared after programmed death protein 1 therapy and she refused to examination and further treatment.