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PD-1 plus CTLA-4 blockade is highly effective in advanced-stage, mismatch repair (MMR)-deficient (dMMR) colorectal cancers, yet not in MMR-proficient (pMMR) tumors. We postulated a higher efficacy of neoadjuvant immunotherapy in early-stage colon cancers. In the exploratory NICHE study ( NCT03026140), patients with dMMR or pMMR tumors received a single dose of ipilimumab and two doses of nivolumab before surgery, the pMMR group with or without celecoxib. The primary objective was safety and feasibility; 40 patients with 21 dMMR and 20 pMMR tumors were treated, and 3 patients received nivolumab monotherapy in the safety run-in. Treatment was well tolerated and all patients underwent radical resections without delays, meeting the primary endpoint. Of the patients who received ipilimumab + nivolumab (20 dMMR and 15 pMMR tumors), 35 were evaluable for efficacy and translational endpoints. Pathological response was observed in 20/20 (100%; 95% exact confidence interval (CI): 86-100%) dMMR tumors, with 19 major pathological responses (MPRs, ≤10% residual viable tumor) and 12 pathological complete responses. In pMMR tumors, 4/15 (27%; 95% exact CI: 8-55%) showed pathological responses, with 3 MPRs and 1 partial response. CD8+PD-1+ T cell infiltration was predictive of response in pMMR tumors. These data indicate that neoadjuvant immunotherapy may have the potential to become the standard of care for a defined group of colon cancer patients when validated in larger studies with at least 3 years of disease-free survival data.


Myriam Chalabi, Lorenzo F Fanchi, Krijn K Dijkstra, José G Van den Berg, Arend G Aalbers, Karolina Sikorska, Marta Lopez-Yurda, Cecile Grootscholten, Geerard L Beets, Petur Snaebjornsson, Monique Maas, Marjolijn Mertz, Vivien Veninga, Gergana Bounova, Annegien Broeks, Regina G Beets-Tan, Thomas R de Wijkerslooth, Anja U van Lent, Hendrik A Marsman, Elvira Nuijten, Niels F Kok, Maria Kuiper, Wieke H Verbeek, Marleen Kok, Monique E Van Leerdam, Ton N Schumacher, Emile E Voest, John B Haanen. Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers. Nature medicine. 2020 Apr;26(4):566-576

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PMID: 32251400

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