A Complete Pathological Response to Pembrolizumab following ex vivo Liver Resection in a Patient with Colorectal Liver Metastases

Baimas-George, Maria; Baker, E.; Kamionek, Michal; Salmon, John Stuart; Sastry, Amit; Levi, David; Vrochides, Dionisios

doi:10.1159/000487814

Cited by 12 publications

(6 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2018 Apr 5;63(2):90–94. [ 16 ] 10 28 F S Wt Mut Por N.A FOLFOX + pembro 2 m 1 Colon, liver, LN N.A FoundationOne Clin Colorectal Cancer. 2018 Jun;17(2):e229-e232.…”

Section: Discussionmentioning

confidence: 99%

Pathologic complete response after laparoscopic surgery following treatment with nivolumab and ipilimumab for anticancer drug-resistant MSI-high descending colon cancer: a case report and literature review

et al. 2022

View full text Add to dashboard Cite

Background Preoperative treatment is performed for locally advanced colon cancer with extensive tumor proximity or suspected invasion of skeletal muscles, major organs, and blood vessels. Oxaliplatin-based regimens are often used in preoperative chemotherapy. However, microsatellite instability (MSI)-high colorectal cancer is often resistant to cytotoxic anticancer agents. Herein, we describe a case of treatment of anticancer drug-resistant MSI-high locally advanced colon cancer and review cases of complete response to immune checkpoint inhibitor therapy for colorectal cancer. Case presentation A 57-year-old woman was referred to our hospital with a large tumor in the descending colon and extensive thoracic and abdominal wall involvement, including the ribs and diaphragm. No distant metastasis was observed. The tumor had perforated the abdominal wall and formed an abscess. Upon visiting our hospital, emergency surgery was performed. An abdominal wall incision was made to drain the abscess and laparoscopic colostomy was performed. Histopathological examination of biopsy specimens revealed an adenocarcinoma with positive immunohistochemical expressions of both CDX2 and CK20. The patient was diagnosed with a descending colon cancer. Genetic examination found MSI-high, Kras mutation (F12G), and wild-type BRAF. After the inflammation improved, chemotherapy with the FOLFIRI regimen was initiated, but the tumor grew rapidly. As a second-line treatment, nivolumab and ipilimumab combination therapy was initiated. After four cycles of these therapies, the patient was administered nivolumab alone for five cycles. Tumor shrinkage was observed and radical surgery was performed. The patient underwent laparoscopic descending colon and partial thoracic and abdominal wall resection. The abdominal wall muscle was dissected from the abdominal cavity, and subcutaneous tissues, diaphragm, ribs were dissected from the body surface. Pathological examination revealed mucus components, fibrous tissues, and no malignant cells, indicating a complete pathological response (pCR). The patient had a good postoperative course and returned to work after being discharged. No recurrence was observed six months postoperatively. Conclusions Herein, we report a case of anticancer drug-resistant MSI-high colon cancer that was resected after treatment with immune checkpoint inhibitors, and a pCR was achieved. This new treatment strategy can be used for the treatment of cases that are not responsive to conventional therapies.

show abstract

“…2018 Apr 5;63(2):90–94. [ 16 ] 10 28 F S Wt Mut Por N.A FOLFOX + pembro 2 m 1 Colon, liver, LN N.A FoundationOne Clin Colorectal Cancer. 2018 Jun;17(2):e229-e232.…”

Section: Discussionmentioning

confidence: 99%

Pathologic complete response after laparoscopic surgery following treatment with nivolumab and ipilimumab for anticancer drug-resistant MSI-high descending colon cancer: a case report and literature review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Immune checkpoint blockade has also been discussed as a neoadjuvant strategy, although studies have reported only a few cases. One case report had shown significant benefits when pembrolizumab was administered in the neoadjuvant setting in a Lynch syndrome patient, who after that qualified for surgical resection [108]. A retrospective study on two patients with locally advanced CRC has shown that nivolumab in the neoadjuvant setting can induce complete responses, either as a single treatment option or followed by surgery [109].…”

Section: Neoadjuvant Settingmentioning

confidence: 99%

Landscape of Immunotherapy Options for Colorectal Cancer: Current Knowledge and Future Perspectives beyond Immune Checkpoint Blockade

Gorzo

Galos

Lungulescu

et al. 2022

Life

View full text Add to dashboard Cite

Colorectal cancer is the third most prevalent malignancy in Western countries and a major cause of death despite recent improvements in screening programs and early detection methods. In the last decade, a growing effort has been put into better understanding how the immune system interacts with cancer cells. Even if treatments with immune checkpoint inhibitors (anti-PD1, anti-PD-L1, anti-CTLA4) were proven effective for several cancer types, the benefit for colorectal cancer patients is still limited. However, a subset of patients with deficient mismatch repair (dMMR)/microsatellite-instability-high (MSI-H) metastatic colorectal cancer has been observed to have a prolonged benefit to immune checkpoint inhibitors. As a result, pembrolizumab and nivolumab +/− ipilimumab recently obtained the Food and Drug Administration approval. This review aims to highlight the body of knowledge on immunotherapy in the colorectal cancer setting, discussing the potential mechanisms of resistance and future strategies to extend its use.

show abstract

“…Due to the low incidence of dMMR or MSI-H in CRC patients, substantial data to support their use in CLM are currently unavailable. A few case reports showed notable response to checkpoint inhibitors [ 46 , 47 ]. In a patient with Lynch syndrome (MSI-H) and CLM treated with neoadjuvant pembrolizumab, a pathologic complete response (CR) was achieved [ 46 ].…”

Section: Immune Checkpoint Inhibitors In Colorectal Liver Metastasesmentioning

confidence: 99%

“…A few case reports showed notable response to checkpoint inhibitors [ 46 , 47 ]. In a patient with Lynch syndrome (MSI-H) and CLM treated with neoadjuvant pembrolizumab, a pathologic complete response (CR) was achieved [ 46 ]. Two patients with locally advanced rectal cancer had dMMR, Lynch syndrome and high tumor mutation burden (TMB) [ 47 ].…”

Section: Immune Checkpoint Inhibitors In Colorectal Liver Metastasesmentioning

confidence: 99%

Perioperative Systemic Chemotherapy for Colorectal Liver Metastasis: Recent Updates

Lee

Woo

2021

Cancers

View full text Add to dashboard Cite

The liver is the most common site of metastases for colorectal cancer. Complete resection in some patients with resectable liver metastases (LM) can lead to long-term survival and cure. Adjuvant systemic chemotherapy after complete resection of LM improves recurrence-free survival; however, the overall survival benefit is not clear. In selected patients, preoperative systemic treatment for metastatic colorectal cancer can convert unresectable to resectable cancer. This review will focus on patient selection, and integration of perioperative and postoperative systemic treatment to surgery in resectable and initially unresectable LM. Additionally, new drugs and biomarkers will be discussed.

show abstract

A Complete Pathological Response to Pembrolizumab following ex vivo Liver Resection in a Patient with Colorectal Liver Metastases

Cited by 12 publications

References 23 publications

Pathologic complete response after laparoscopic surgery following treatment with nivolumab and ipilimumab for anticancer drug-resistant MSI-high descending colon cancer: a case report and literature review

Pathologic complete response after laparoscopic surgery following treatment with nivolumab and ipilimumab for anticancer drug-resistant MSI-high descending colon cancer: a case report and literature review

Landscape of Immunotherapy Options for Colorectal Cancer: Current Knowledge and Future Perspectives beyond Immune Checkpoint Blockade

Perioperative Systemic Chemotherapy for Colorectal Liver Metastasis: Recent Updates

Contact Info

Product

Resources

About