ArticleJournal of gastrointestinal cancer2025
Efficacy of Radiotherapy Combined with Immunotherapy in MSS/pMMR Metastatic Colorectal Cancer: a Propensity-Matched Retrospective Study.
Article in Journal of gastrointestinal cancer, 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
purposeMicrosatellite-stable (MSS) or mismatch repair-proficient (pMMR) metastatic colorectal cancer (mCRC) responds poorly to immune checkpoint inhibitors (ICIs). We investigated whether combining ICIs with radiotherapy (RT) promotes distant tumor regression and improves survival.
methodsWe retrospectively analyzed patients with MSS/pMMR mCRC treated with ICIs between October 2021 and November 2024. According to RT use, patients were divided into RT and non-RT (NRT) groups. Propensity score matching (PSM) was used to minimize selection bias. The primary endpoint was the out-of-field (abscopal) response rate (ARR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints included overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs), graded using Common Terminology Criteria for Adverse Events version 5.0.
resultsAfter PSM, 40 matched pairs were generated from the RT (n = 46) and NRT (n = 83) groups. ARR was higher in the RT group than in the NRT group (22.5% vs. 5.0%, p = 0.023). Median OS and PFS did not differ significantly between groups. Cox regression showed that pulmonary metastasis (p = 0.019) was an independent prognostic factor for OS. RT (hazard ratio = 0.466, p = 0.005) and neutrophil-to-lymphocyte ratio (p = 0.001) were independently associated with PFS. Lymphocytopenia was more frequent in the RT group (p = 0.006), with no other significant differences in TRAEs.
conclusionRT combined with ICIs significantly improved ARR in MSS/pMMR mCRC, suggesting clinical benefit with a manageable toxicity profile and supporting further investigation of this combination.
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