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CASE REPORT article

Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1407312
This article is part of the Research Topic Precision Therapy in Colorectal Cancer View all 5 articles

Efficacy and Challenges of Anti-PD1 in MSI-H mCRC: A Case Report on Concurrent Infections and ir-AIHA

Provisionally accepted
Xiaxia Pei Xiaxia Pei 1Jun Zhao Jun Zhao 2*Ruiying Luo Ruiying Luo 2*Tian Kun Tian Kun 1Lijun Da Lijun Da 1*Enxi Li Enxi Li 1*Hao Zhu Hao Zhu 1*Yanhong Li Yanhong Li 3*Yaoting Luo Yaoting Luo 1*Zhiping Wang Zhiping Wang 4*Feixue Song Feixue Song 1*
  • 1 Department of Oncology, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
  • 2 Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
  • 3 Institute of Hematology, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
  • 4 Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China

The final, formatted version of the article will be published soon.

    Anti-programmed cell death protein 1 (PD-1) therapy has demonstrated notable efficacy in treating patients with deficient mismatch repair/high microsatellite instability (dMMR/MSI-H) metastatic colorectal cancer (mCRC). However, its clinical application is fraught with challenges and can lead to significant immune-related adverse events (ir-AEs). In this report, we present a complicated case of an mCRC patient with MSI-H and mutations in β2M and LRP1B proteins, complicated by concurrent bacteremia and liver fluke infection, who received first-line anti-PD1 therapy. The patient exhibited a positive response to anti-PD1 treatment, even in the presence of concomitant antibiotic and anti-parasitic interventions.Additionally, the patient experienced immunotherapy-related autoimmune hemolytic anemia (ir-AIHA), a rare hematological ir-AE, which was effectively treated later on.Immunotherapy represents a pivotal and highly effective approach to tumor treatment. Baseline assessment of the MMR and MSI status is a crucial step before initiating immunotherapy, and regular ongoing assessments during the treatment course can facilitate early recognition of any secondary complications, enabling prompt intervention and ensuring optimal therapeutic outcomes. Overall, a multidisciplinary diagnostic and therapeutic algorithm can help maximize the therapeutic benefits of immunotherapy.

    Keywords: High microsatellite instability, Metastatic colorectal cancer, Immunotherapy, Bacteremia, liver fluke, immunotherapy-related autoimmune hemolytic anemia with Immunotherapy

    Received: 26 Mar 2024; Accepted: 25 Jul 2024.

    Copyright: © 2024 Pei, Zhao, Luo, Kun, Da, Li, Zhu, Li, Luo, Wang and Song. 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:
    Jun Zhao, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Ruiying Luo, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Lijun Da, Department of Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Enxi Li, Department of Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Hao Zhu, Department of Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Yanhong Li, Institute of Hematology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Yaoting Luo, Department of Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Zhiping Wang, Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China
    Feixue Song, Department of Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.