ArticleInternational journal of colorectal disease2025
Neoadjuvant triple-modality therapy with immune checkpoint blockade, anti-angiogenesis, and chemotherapy enhances pathologic response and survival in locally advanced and metastatic colorectal cancer: a multicenter cohort study.
Article in International journal of colorectal disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe current study seeks to investigate the clinical outcomes of combining immune checkpoint blockade, anti-angiogenesis, and chemotherapy in neoadjuvant treatment for individuals diagnosed with locally advanced (high-risk Stage III or initially unresectable Stage III) or resectable/unresectable Stage IV colorectal cancer, including metastatic cases.
methodsA total of 120 individuals diagnosed with advanced colorectal cancer (stage III: n = 65; stage IV: n = 55; metastatic sites: liver n = 30, lung n = 15, peritoneal n = 10) were enrolled at three hospitals between February 2021 and December 2022. All patients underwent biopsy and pathology confirmation. Based on the treatment plan, patients were categorized into a control group (n = 60) receiving standard FOLFOX/FOLFIRI chemotherapy and an experimental group (n = 60) receiving a combination of pembrolizumab (200 mg IV q3w), bevacizumab (5 mg/kg IV q2w), and FOLFOX regimen (oxaliplatin 85 mg/m
resultsAfter a 6-week treatment period, the experimental group showed a more significant reduction in VEGF (Δ = 132.0 pg/mL vs. 57.9 pg/mL) and bFGF (Δ = 51.4 pg/mL vs. 20.1 pg/mL) compared to the control group (P < 0.001). The experimental group demonstrated higher CD4 + /CD8 + ratios post-treatment (1.65 vs. 1.23, P < 0.01) and greater reductions in CA 19-9 (Δ = 42.5 U/mL vs. 23.8 U/mL) and CEA (Δ = 12.6 ng/mL vs. 6.9 ng/mL) (P < 0.01). Response rates (CR + PR: 40.0% (Experimental: 8.3% CR + 31.7% PR) vs. 18.4% (Control: 1.7% CR + 16.7% PR); DCR: 46.7% vs. 25.0%) and survival outcomes (median OS: 32.26 vs. 28.55 months; median PFS: 6.37 vs. 4.58 months) were superior in the experimental group (P < 0.05).
conclusionCombining neoadjuvant therapy with immune checkpoint blockade, anti-angiogenesis, and chemotherapy significantly improves tumor downstaging (as evidenced by pathologic complete response rates of 18% in the experimental group vs. 5% in the control group among resected patients) and survival outcomes, presenting a promising therapeutic approach for locally advanced and oligometastatic colorectal cancer.
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