Traditionally, colorectal cancer is treated with surgery followed by chemotherapy, but newer clinical data suggest alternative sequencing, writes SciTechDaily.
In a UK phase trial, patients with stage II and III colorectal cancer were treated with immunotherapy before surgery.
Participants received up to nine weeks of treatment with pembrolizumab prior to surgery, after which their disease course was systematically monitored.
The UCL trial included 32 patients with a specific genetic profile, representing a small proportion of colorectal cancer cases.
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This subgroup is known to respond differently to treatment compared with other patients.
Biological mechanisms and monitoring
Alongside treatment, individualized blood tests were developed to measure circulating tumor DNA.
These analyses made it possible to identify early signs of treatment response and assess the risk of recurrence.
The results showed a clear correlation between the disappearance of tumor DNA in the blood and the absence of disease over time.
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In addition, immunoprofiling of tumor tissue was used to predict which patients were most likely to benefit from the treatment.
Implications for future treatment
Long-term follow-up over 33 months showed no cases of recurrence among participants, a marked contrast to standard treatment courses, where around a quarter of patients experience recurrence within three years.
At the same time, significant tumor reduction prior to surgery was observed in a large proportion of patients.
These results indicate that immunotherapy before surgery may change the prognosis for selected colorectal cancer patients and potentially reduce the need for subsequent treatment.
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The timing of treatment may be crucial for long-term disease control in specific patient groups.
Sources: SciTechDaily and UCL.