Surgery first for coloncancer? Not so fast, according to new study
Radiologic response among patients with different clinical T stage; patients with cT2–3 disease were more likely to achieve CR.Abbreviations: CR, complete response; N/A, TRG not available because surgery was not performed or the tumor was unresectable; PD, progressive disease; PR, partial response; SD, stable disease; TRG, tumor regression grade.Surgery After Neoadjuvant Therapy
As of writing, surgery had been performed on 50 patients; 40 with PR, 9 with SD, and 1 with PD . Median time from initiation of PD-1 blockade to surgery was 4.0 months . All of these patients, except one who received ostomy due to unresectable tumor, underwent R0 resection for the primary tumor. pCR was observed in patients with PR but not in those with SD or PD . The rate of pCR + cCR was 61.6%.
As of writing, none of the patients undergoing surgery had experienced recurrence, including 16 who did not receive any treatment after the surgery and 18 who had a poor TRG . None of the patients achieving cCR experienced tumor relapse. Overall median DFS and OS were not reached . The 2-year rates of tumor-specific OS and DFS were both 100%. Of note, the only patient with PD underwent R0 surgery and remained disease-free after 13.4 months of follow-up.).
Postoperative complications were analyzed among the 51 patients undergoing surgery. Severe complications were observed in 4 patients: adhesive intestinal obstruction , abdominal infection , anastomotic leak , and abdominal bleeding ; 3 of these 4 patients required a second surgery. No deaths occurred within 1 month after the surgery.
Although PD-1 inhibitors have been proven highly effective for dMMR/MSI-H CRC, more than half of the patients with mCRC did not experience response.
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