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Immunotherapy prior to surgery could become a ‘game-changer’ for patients with high-risk bowel cancers, potentially avoiding the need for chemotherapy, according to a new study.
The phase II clinical trial found that pembrolizumab (Keytruda) is a ‘highly effective’ treatment in comparison to conventional chemotherapy.
The study was led by UCL, UCLH, the Christie NHS Foundation Trust in Manchester, St. James’s University Hospital in Leeds, University Hospital Southampton and the University of Glasgow, and the findings were presented at the American Society of Clinical Oncology (ASCO) Annual Meeting 2024.
All patients on the trial were cancer-free after treatment
Around 10-15% of patients with stage two or three bowel cancer have MMR deficient/MSI-High bowel cancer, representing around 2,000-3,000 cases per year in the UK. In total, 32 patients with this genetic profile were recruited from five hospitals in the UK.
Patients were given nine weeks of pembrolizumab prior to surgery instead of the usual treatment of chemotherapy and surgery, then monitored over time.
During a mean follow up period of 10 months, 59% of patients had no signs of cancer after treatment with pembrolizumab, and the remaining 41% of patients had any remaining tumours removed with surgery. The approach meant that patients did not require any post-operative chemotherapy.
All of the patients in the trial were cancer-free after treatment and are still cancer-free many months later. With standard chemotherapy, less than 5% have no signs of cancer after surgery.
Immunotherapy could eventually ‘replace the need for surgery’
The researchers involved in the trial described the results as “exciting” but warn that more research will need to be done to confirm whether these outcomes are sustained over time.
Professor Mark Saunders, a Consultant Clinical Oncologist at The Christie, said: “This is a really very exciting new treatment for the 10-15% of patients who have the right genetic make-up. Immunotherapy prior to surgery could well become a ‘game-changer’ for these patients with this type of cancer. Not only is the outcome better, but it saves patients from having more conventional chemotherapy, which often has more side-effects.
“In the future, immunotherapy may even replace the need for surgery. However, more trials are needed to confirm these exciting early results.”
Dr Marnix Jansen, a Clinician Scientist and Consultant Histopathologist who is leading the translational research on the trial said: “More work needs to be done to assess pembrolizumab before it could be considered standard treatment, but given the quality of the outcomes in this trial I think it’s possible that we could see it in the clinic within a couple of years if subsequent trials are similarly successful.”
