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Dr Kristen Ciombor: Neoadjuvant Immunotherapy in CRC Reduces Need for Other Treatments


Kristen K. Ciombor, MD, MSCI, associate professor at Vanderbilt University discusses why neoadjuvant immunotherapy is superior to other immunotherapy treatments in colorectal cancer.

Neoadjuvant immunotherapy produces better results and reduces risk of recurrence in patients with colorectal cancer, said Kirsten K. Ciombor, MD, MSCI, associate professor of medicine at Vanderbilt University, speaking at an Institute for Value-Based Medicine® meeting.


Why is neoadjuvant immunotherapy superior in colorectal cancer as a way to achieve better responses and reduce recurrence?

Immunotherapy has been important for a while in the metastatic setting. We saw improvements in patient outcomes after they had already received chemotherapy as a next line of therapy. And we know that's important. And now, in the first line, patients are eligible for immunotherapy with metastatic disease as long as it’s MSI [microsatellite instability]-high or mismatch repair deficient.

However, we’re starting to see emerging data that in colon and rectal cancer, specifically, using immunotherapy as a neoadjuvant approach can actually reduce the amount of other treatment that's needed.

For instance, with rectal cancer, typically patients are treated with radiation, with chemotherapy, systemic chemotherapy outside of radiation, and surgery—sometimes 2 surgeries—in order to cure these diseases. However, what we're starting to see is that by using immunotherapy, sometimes we can avoid radiation, avoid surgery, avoid many of the other treatments that patients have to go through.

Not only can we avoid those treatment modalities, potentially with the same rates or higher rates of cure, but we also avoid all the toxicities from these therapies as well.

It really benefits patients to know if they're MSI-high upfront and to potentially treat them in a way that’s targetable to their tumor.

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