Professor Gu Yanhong: Multi-line chemotherapy for colorectal cancer failed, but immunotherapy achieved tumor remission and helped chronic disease management

*Only for medical professionals to read and reference.
It shows its strength.
Envolizumab brings a new treatment option for patients with MSI-H/dMMR advanced colorectal cancer! According to the latest statistics from the World Health Organization in 2020, the number of new cases of colorectal cancer in China exceeded 550,000, ranking second among all malignant tumors in China
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In recent years, immunotherapy has developed rapidly, and immunotherapy has significantly prolonged the survival time of tumor treatment.
Studies have confirmed that colorectal cancer patients with microsatellite high instability/mismatch repair gene deficiency (MSI-H/dMMR) are resistant to immune checkpoint inhibition.
sensitive to drugs (ICIs)
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Today, the concept of "precision therapy" is widely accepted in the field of tumor therapy, and nvolimab has delivered a satisfactory answer in "precision immunity"
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Envolizumab is a subcutaneous PD-L1 inhibitor independently developed in China.
Compared with existing PD-1/PD-L1 inhibitors, it has advantages in terms of administration and safety
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Based on the results of its Phase II registration study, Nvolizumab was approved by the National Medical Products Administration (NMPA) of China on November 25 for the treatment of adult patients with advanced solid tumors with MSI-H/dMMR
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In this regard, the Medical Oncology Channel specially invited Professor Gu Yanhong from the Department of Oncology of Jiangsu Provincial People's Hospital to share a wonderful case in the Phase II trial of Envolumab, and to conduct in-depth discussions on the experience and efficacy of Envolizumab
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Immunotherapy expands its territory, and envolizumab brings new options for late-line treatment.
Talking about the current status of treatment of MSI-H/dMMR patients, Professor Gu Yanhong said: "MSI-H/dMMR colorectal cancer patients are more sensitive to PD-1 Immunotherapy represented by inhibitors is more sensitive, and immunotherapy can benefit patients with MSI-H, while patients with MSS/MSI-L have not achieved significant remission
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Improving MSI detection can predict immunotherapy in patients with metastatic colorectal cancer in advance efficacy [1]
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The "Expert Consensus on High-throughput Sequencing for Molecular Detection of Colorectal Cancer" in 2021 clearly pointed out that microsatellite/mismatch repair (MSI/MMR) is a 'must be detected biomarker' for colorectal cancer [2]
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MSI-H/dMMR colorectal cancer patients belong to the 'predominant population' of immunotherapy.
In recent years, immunotherapy has continued to expand its territory among the dominant population, from late-line treatment, first-line treatment, to early-stage disease.
Adjuvant therapy showed curative effect
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For MSI-H/dMMR colorectal cancer, immunotherapy will become an important treatment component [3]
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The recently launched subcutaneous injection of the original Chinese PD-L1 inhibitor, Nvolimumab, provides a new option for the post-treatment of colorectal cancer patients.
- Good outcomes in H/dMMR colorectal cancer patients
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The results of the study showed that the objective response rate (ORR) of 65 patients with MSI-H/dMMR colorectal cancer above second-line treatment was 43.
1%; 12-month progression-free survival (PFS) ) rate was 43.
7%, and the 12-month overall survival (OS) rate was 72.
9% [4], which was not inferior to other PD-1/PD-L1 inhibitors in efficacy
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"Post-line use of nvolimab in patients with stage IV rectal cancer ushered in life.
As a participant in the domestic clinical phase II study of nvolimab, Professor Gu Yanhong shared a case that impressed her: a female patient, 53 years old, In 2002, he underwent colon cancer surgery, and received chemotherapy 3 times after surgery.
After that, he stopped chemotherapy on his own.
In March 2018, he developed blood in the stool without obvious cause.
On May 31, CT of the chest + whole abdomen showed: rectal mass, multiple small lymph nodes around the rectum, consistent with rectal cancer, no abnormal density lesions in the liver parenchyma, fibrous shadows in the middle field of the right lung, and old lesions were considered, 2018 On June 5, 2008, "extended radical resection of rectal cancer under general anesthesia" was performed.
Postoperative pathology: (rectal) mucinous adenocarcinoma, grade II, ulcer type, tumor size 3*3*0.
8cm, pT3N1bMx
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After surgery, he received 5 times of XELOX chemotherapy.
On January 24, 2019, due to intolerance to oxaliplatin, the chemotherapy was adjusted to oral capecitabine monotherapy for one cycle
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On March 1, 2019, the re-examination of the liver magnetic resonance imaging (MRI) in our hospital showed abnormal signal shadows in the right hepatic lobe, and metastases appeared in the abdominal wall.
Compared with the CT on May 31, 2018, the possibility of metastasis was considered
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The patient's constitution was weak, and after completing the MSI examination and comprehensive evaluation, the patient was enrolled in our hospital "Clinical efficacy and safety of nvolimumab in the treatment of patients with MSI-H/dMMR advanced colorectal cancer and other advanced solid tumors.
" Multicenter Phase II Clinical Study"
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From April 24, 2019 to November 26, 2020, envolimumab treatment (150mg QW) was performed, during which the abdominal wall lesions continued to shrink, and liver metastases were also controlled
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During the treatment, the adverse reactions of the patient were grade 1 hypothyroidism and grade 1 proteinuria, and the diet and physical condition were also improved compared with those before treatment
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April 9, 2019 Patient's baseline CT VS 2020-04-01 Review CT April 9, 2019 Patient's baseline CT VS December 3, 2020 The subcutaneous injection method improves the convenience of administration and significantly reduces the risk of adverse reactions Prof.
Gu Yanhong said, "The way of administration of Envolimumab is different from that of general immune checkpoint inhibitors.
It is administered by subcutaneous injection, which is relatively stable at room temperature and is more stable at room temperature.
There are fewer restrictions on the injection site, and the administration can be easily completed
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In addition, the subcutaneous administration method avoids the occurrence of intravenous infusion reactions and shortens the administration time, even if the patient is at home or in the nearest community hospital.
The administration can be completed, which significantly reduces the travel and related expenses for medical treatment, and avoids the risk of infusion reactions
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Data from the recent phase I clinical study of nvolimumab also provided pharmacokinetic results for subcutaneous dosing regimens of 300 mg Q3W or 400 mg Q4W, supporting a fixed dose of nvolimumab at 300 mg Q3W or 400 mg Q4W The follow-up clinical exploration of the dosing regimen is expected to further improve the convenience of nvolimab administration and enhance the patient's medication experience [5]
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"Translational therapy creates "cure" opportunities, and preoperative immunotherapy is expected to reverse the tide.
For patients with operable or potentially operable colorectal cancer, Professor Yanhong Gu shared the current clinical treatment strategies: "For colorectal cancer patients with MSI-H/dMMR For cancer patients, in order to pursue maximum tumor regression, immune checkpoint inhibitors can be considered for transformation therapy
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The advantage of preoperative immunotherapy is that most of the cells expressing the targets of immune checkpoint inhibitors exist in the tumor before surgery, so the tumor antigens released during immunotherapy help to activate a large number of tumor-infiltrating lymphocytes and cause lasting anti-tumor effects
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The immune activation effect produced by the body after immunotherapy can eliminate tumor micrometastasis, shrink the tumor, and maximize the anti-tumor effect of the body before surgery [6]
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KEYNOTE-177 is a landmark study in the history of colorectal cancer research, leading the first-line treatment of colorectal cancer into the era of precision immunotherapy
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The KEYNOTE-177 study is also of great significance in the field of translational therapy.
Once the opportunity for surgery is successfully obtained through immune checkpoint inhibitor translational therapy, surgical resection can be performed, and the prognosis is relatively good
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"CSCO Colorectal Cancer Diagnosis and Treatment Guidelines (2021)" adds a new note in the treatment of unresectable colon cancer: Based on the results of the KEYNOTE-177 study, patients with MSI-H/dMMR may consider using PD in conversion therapy or palliative care -1 inhibitor immunotherapy [7]
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We have also had similar patients in the clinic who received nvolimumab treatment, and the patients also had the opportunity of surgical resection
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This also shows that nvolimumab has certain advantages in conversion therapy or palliative therapy for MSI-H/dMMR colorectal cancer patients
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We also look forward to more exploration of nvolimumab in patients with operable or potentially operable colorectal cancer to benefit more patients
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"Expert Profile Professor Gu Yanhong Deputy Director, Chief Physician, Doctoral Supervisor, Postdoctoral Workstation Supervisor of the Oncology Department of the First Affiliated Hospital of Nanjing Medical University Member of the National Colorectal Tumor Quality Control Expert Committee Member of the National Anticancer Drug Clinical Application Monitoring Expert Committee Colorectal Cancer Group Expert Vice-chairman of the Colorectal Cancer Youth Committee of the Chinese Medical Doctor Association Member of the Standing Committee of the Colorectal Cancer Expert Committee of the Chinese Society of Clinical Oncology Member "14th Five-Year Plan" National Health and Medical Commission "Introduction to Oncology" textbook editorial board National Natural Science Foundation of China Major Research Program PI References: [1] Xie Ronghui, Xie Zhong.
Research progress in colorectal cancer with MSI-H characteristics[J] ].
Clinical Medical Research and Practice, 2021, 6(16): 196-198.
[2] Professional Committee of Cancer Targeted Therapy of China Anti-Cancer Association.
Chinese expert consensus on high-throughput sequencing of colorectal cancer molecular detection [J].
Clinical Journal of Oncology, 2021, 26(3): 253-264.
[3] Chen Gong.
Status and progress of immunotherapy for colorectal cancer [J].
Journal of Precision Medicine, 2019, 34(01): 1-5.
[4 ]Li J, Deng Y, Zhang W, et al.
Subcutaneous envafolimab monotherapy in patients with advanced defective mismatch repair/microsatellite instability high solid tumors[J].
Journal of Hematology & Oncology, 2021, 14(1): 95.
[5 ]Papadopoulos KP, Harb W, Peer CJ, et al.
First-in-Human Phase I Study of Envafolimab, a Novel Subcutaneous Single-Domain Anti-PD-L1 Antibody, in Patients with Advanced Solid Tumors.
Oncologist[J].
2021 ;26(9):e1514-e1525.
[6] Cao Qihua, Xu Yanbo, Xu Dong.
Research progress of immune checkpoint therapy for colorectal cancer [J].
Cancer Prevention and Treatment Research, 2021, 48(03): 229-233.
[7] Guidelines Working Committee of Chinese Society of Clinical Oncology.
Chinese Society of Clinical Oncology (CSCO) Colorectal Cancer Diagnosis and treatment guidelines 2021[M].
Beijing: People's Health Publishing House, 2021: 61-62.
*This article is only for providing scientific information to medical professionals and does not represent the views of this platform