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SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1540751
This article is part of the Research Topic Precision Oncology in Checkpoint Immunotherapy: Leveraging Predictive Biomarkers for Personalized Treatment View all 16 articles
The neoadjuvant immunotherapy for non-metastatic mismatch repair-deficient colorectal cancer: a systematic review
Provisionally accepted- 1 Department of Pharmacy, Cancer Hospital of China Medical 6 University. Liaoning Cancer Hospital & Institute, Shenyang, China
- 2 Department of general surgery, Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
- 3 Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute,, Shenyang,, China
Background: Immunotherapy had become the first-line treatment for metastatic mismatch repair deficient (dMMR) colorectal cancer. The efficacy and safety of neoadjuvant immunotherapy for the treatment of non-metastatic dMMR colorectal cancer remained unclear. We tried to explore clinical effect and safety of neoadjuvant immunotherapy for non-metastatic dMMR colorectal cancer.We collected clinical data from the databases (PubMed, Wanfang Embase, Cochrane Library and China National Knowledge Infrastructure databases) up to November 2024. The primary outcomes of major pathological response (MPR), pathological complete response (pCRs) and other outcomes were analyzed for the final results. The secondary outcomes (pCRs for the subgroups) were also analyzed.We included 21 articles with 628 non-metastatic dMMR colorectal cancers. PCRs was found in 320/480 (66.6%) patients (ES: 0.70, 95% CI: 0.66 to 0.74) with the fixed-effects model and little heterogeneity. MPR was found in 388/452 (85.8%) patients (ES: 0.86, 95% CI: 0.81 to 0.91) with the fixed-effects model and little heterogeneity. In the subgroup analysis, pCRs was similar in the T1-T3 group and T4a-T4b group in the fixed-effects model with minimal heterogeneity (OR: 0.76, 95% CI: 0.48 to 1.22). PCRs was similar in the colon cancer group and rectal cancer group in the fixed-effects model with minimal heterogeneity (OR: 1.41, 95% CI: 0.39 to 5.12). The similar pCRs was found in immune monotherapy group and immunetherapy plus chemotherapy group (OR: 0.74, 95% CI: 0.26 to 2.10) with the fixed-effects model and little heterogeneity.Neoadjuvant immunotherapy could achieve high pCRs and MPR for non-metastatic dMMR colorectal cancer. For locally advanced T4 stage dMMR colorectal cancer, neoadjuvant immunotherapy can still achieve good pCRs rates. Neoadjuvant immune monotherapy could achieve good pCR rates, avoiding the toxic side effects caused by combined dual immunotherapy and chemo(radio)therapy. Neoadjuvant immunotherapy could be another treatment option for non-metastatic dMMR colorectal cancer.
Keywords: neoadjuvant immunotherapy, non-metastatic colorectal cancer, Mismatch repair-deficient, PCRs, Meta-analysis
Received: 06 Dec 2024; Accepted: 07 Apr 2025.
Copyright: © 2025 Cui, Yang, Zhao, Wang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xin Liu, Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute,, Shenyang,, China
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