July 22, 2024

Taylor Daily Press

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Preoperative immunotherapy is very successful in colon cancer

Preoperative immunotherapy is very successful in colon cancer

In the month before surgery, colon cancer patients received two cycles of immunotherapy with nivolumab and ipilimumab. In 95% of patients, only 10% or fewer cancer cells were present at the time of surgery, and in 68% no living cancer cells were found. The success doesn’t stop there, because no less important is the fact that so far none of the patients’ cancer has recurred during an average of more than two years of follow-up.

The first signs of success were quickly found a few years ago after internal oncologist Myriam Chalabi, MD, began the NICHE study. Chalabi: “We wanted to study what immunotherapy could mean for people with non-metastatic colon cancer. Then we saw something that almost never happens: all the patients in the study group responded well to the new treatment. Four years ago, Chalabi and her colleagues published the results of this study on the first 20 patients with this type of colon cancer. “These 20 patients with MSI colon cancer all benefited from the treatment, something we had never seen before.”

Neoadjuvant immunotherapy

Immunotherapy before surgery is called neoadjuvant immunotherapy. Its purpose is to prevent the cancer from coming back or spreading and, in the case of larger tumors, to facilitate surgery. The main idea behind this is that the immune system deals with all the errors in the tumor before it is removed, and is thus stimulated more effectively to destroy the cancer cells.

It is not a living cancer cell

Following this success, the study was expanded to include a larger group of patients to see if immunotherapy could also prevent metastases in the long term. The results are once again promising: 111 patients with MSI colon cancer who were almost completely cured are responding very well to this very short treatment with immunotherapy. “This specific type of colon cancer has many errors in the DNA, which makes the cancer cells easier to detect by the immune system. “The immune system only needs a small stimulus to successfully attack those cancer cells,” Chalabi explains of the success of the treatment.

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Unprecedented results

Chalabi: “After more than two years of treatment, the disease has not returned in any patient, even though they were largely high-risk tumors. The results are unprecedented. Both the effect and side effects are much better than, for example, preoperative chemotherapy, to which only 1 in 20 patients responds.

at the clinic

The investigated treatment is not currently available to patients in the Netherlands. “This study aims to make the treatment available to all patients with this type of colon cancer. At the end of this year we followed the patients for three years. If the majority of patients are still disease-free, the new treatment can be considered standard treatment.

Chalabi: “We have now reached the point where we no longer have to give chemotherapy to colon cancer patients who respond well to the new immunotherapy in these and similar studies after surgery. The next and very important step is to make this treatment available as standard treatment. We are currently working hard.” To achieve this, eventually we hope to be able to omit the procedure for patients who respond well.

Standing applause

Two years ago, Chalabi presented preliminary findings at a major international conference. There she received a standing ovation for her work and earned her the X (formerly Twitter) phenomenon. #challabeplot on me. This refers to a graph she showed in her presentation showing the impressive result of the study. “I still get goosebumps when I think about that moment. The positive sentiment in the room was unmistakable: These findings could dramatically improve future patient outcomes.”

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