ReviewJournal of gastrointestinal cancer2026
Optimal First-Line Immunotherapy for MSI-H/dMMR Metastatic Colorectal Cancer: Evidence, Gaps, and Clinical Decision-Making.
Review in Journal of gastrointestinal cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimMicrosatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) metastatic colorectal cancer (mCRC) has emerged as a model for biomarker-driven immunotherapy. Yet the optimal positioning of pembrolizumab, nivolumab, and nivolumab plus ipilimumab in routine practice remains unsettled.
methodsThis narrative review examines landmark and contemporary evidence from KEYNOTE-164, KEYNOTE-177, CheckMate 142, CheckMate 8HW, and the COMMIT trial, together with high-quality non-randomized cohort studies and ongoing trial data.
resultsPembrolizumab is the most mature first-line single-agent standard, with superior progression-free and overall survival versus chemotherapy and a well-characterized long-term safety profile. Nivolumab plus ipilimumab provides the strongest evidence for intensified dual checkpoint blockade and has demonstrated superiority over both chemotherapy and nivolumab monotherapy in randomized trials, but at the cost of substantially higher immune-related toxicity and treatment discontinuation rates. The COMMIT trial suggests a role for chemo-immunotherapy combinations, though sample size and early closure limit interpretation. Key factors influencing treatment selection include disease burden, metastatic pattern, performance status, biomarker confidence, and ability to manage immune-related adverse events.
conclusionIn the absence of a direct head-to-head comparison between pembrolizumab and nivolumab plus ipilimumab, treatment selection must integrate evidence strength, toxicity profile, patient fitness, and biologic context. Ongoing trials, including SEAMARK and the overall survival analysis of CheckMate 8HW, will further refine optimal first-line strategy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.