Niu CG, Zhang J, Rao AV, Joshi U, Okolo P. Comparative effectiveness of immunotherapy and chemotherapy in patients with metastatic colorectal cancer stratified by microsatellite instability status. World J Clin Oncol 2024; 15(4): 540-547 [PMID: 38689622 DOI: 10.5306/wjco.v15.i4.540]
Corresponding Author of This Article
Chen-Gu Niu, MD, Assistant Professor, Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, United States. chenguniu@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Apr 24, 2024; 15(4): 540-547 Published online Apr 24, 2024. doi: 10.5306/wjco.v15.i4.540
Comparative effectiveness of immunotherapy and chemotherapy in patients with metastatic colorectal cancer stratified by microsatellite instability status
Chen-Gu Niu, Jing Zhang, Aniket-Vijay Rao, Utsav Joshi, Patrick Okolo
Chen-Gu Niu, Aniket-Vijay Rao, Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
Jing Zhang, Department of Psychiatry, Rainier Springs, Vancouver, WA 98663, United States
Utsav Joshi, Department of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL 33606, United States
Patrick Okolo, Department of Gastroenterology, Rochester General Hospital, Rochester, NY 14621, United States
Author contributions: All authors jointly conceptualized the article. Okolo P critically revised the manuscript and provided substantial feedback; Okolo P and Zhang J were responsible for the statistical analysis; Niu CG, Zhang J, Rao AV and Joshi U conducted the literature review and drafted the manuscript. All authors approved the final version of the manuscript.
Institutional review board statement: The present study was a database analysis using de-identified data; therefore, institutional review board approval was not required for this type of study.
Conflict-of-interest statement: All the authors declare no conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author at chenguniu@gmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Chen-Gu Niu, MD, Assistant Professor, Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, United States. chenguniu@gmail.com
Received: December 28, 2023 Peer-review started: December 28, 2023 First decision: January 19, 2024 Revised: March 19, 2024 Accepted: March 21, 2024 Article in press: March 21, 2024 Published online: April 24, 2024
Abstract
BACKGROUND
Immunotherapy have demonstrated promising outcomes in patients with high microsatellite instability (MSI) (MSI-H) metastatic colorectal cancer. However, the comparative effectiveness of Immunotherapy and chemotherapy for patients with low MSI (MSI-L), and microsatellite stable (MSS) metastatic colorectal cancer remains unclear.
AIM
To investigate immunotherapy vs chemotherapy for treatment of MSI-L/MSS metastatic colorectal cancer, and to evaluate the success of immunotherapy against chemotherapy in managing MSI-H metastatic colorectal cancer during a follow-up of 50 months.
METHODS
We conducted a retrospective cohort study using the National Cancer Database (NCDB) to evaluate the overall survival (OS) of patients with metastatic colorectal cancer treated with immunotherapy or chemotherapy. The study population was stratified by MSI status (MSI-H, MSI-L, and MSS). Multivariable Cox proportional hazard models were used to assess the association between treatment modality and OS, adjusting for potential confounders.
RESULTS
A total of 21951 patients with metastatic colorectal cancer were included in the analysis, of which 2358 were MSI-H, and 19593 were MSI-L/MSS. In the MSI-H cohort, immunotherapy treatment (n = 142) was associated with a significantly improved median OS compared to chemotherapy (n = 860). After adjusting for potential confounders, immunotherapy treatment remained significantly associated with better OS in the MSI-H cohort [adjusted hazard ratio (aHR): 0.57, 95% confidence interval (95%CI): 0.43-0.77, P < 0.001]. In the MSS cohort, no significant difference in median OS was observed between immunotherapy treatment and chemotherapy (aHR: 0.94, 95%CI: 0.69-1.29, P = 0.715).
CONCLUSION
In this population-based study using the NCDB, immunotherapy treatment was associated with significantly improved OS compared to chemotherapy in patients with MSI-H metastatic colorectal cancer, but not in those with MSI-L/MSS metastatic colorectal cancer. Further studies are warranted to determine the optimal therapeutic approach for patients with MSI-L/MSS metastatic colorectal cancer.
Core Tip: Our population-based study demonstrates that immunotherapy treatment is associated with significantly improved overall survival in patients with high microsatellite instability (MSI-H) metastatic colorectal cancer. However, immunotherapy does not significantly benefit patients with microsatellite stable (MSS) metastatic colorectal cancer. The lower response rates to immunotherapy in MSS tumors can be attributed to the lower tumor mutational burden and reduced immunogenicity compared to MSI-H tumors. These findings indicate that while immunotherapy is a promising treatment for MSI-H colorectal cancer, its efficacy in MSS cases remains uncertain, warranting further investigation to develop targeted therapies for these patients.
