Patients Surgical Journey: strategies for patients living with dMMR/MSI CRC. To benefit patients, advance scientific understanding and aid next trial designs, a Multidisciplinary Team approach is essential.
🔍 Key insights discussed include:
• Early-stage dMMR/MSI-H colon cancers are highly immunogenic, making them particularly responsive to checkpoint inhibitor therapy
• The NICHE-2 trial reported remarkable outcomes with neoadjuvant nivolumab plus ipilimumab, including 97% major pathologic response and 67% pathologic complete response rates
• New phase III studies, including AZUR-2 and NeoShot III, are evaluating whether perioperative immunotherapy can improve long-term outcomes compared with current standards
• ctDNA is emerging as a promising biomarker to identify molecular response, guide treatment duration, and potentially support de-escalation of therapy
• Accurate MMR/MSI testing and high-quality radiologic staging are essential when selecting patients for neoadjuvant immunotherapy
• As outcomes continue to improve, future strategies may allow less treatment, fewer surgeries, and more personalized care for selected patients
These data highlight a rapidly evolving treatment paradigm, where biomarker-driven neoadjuvant immunotherapy may transform the management of localised MSI-H colon cancer.
Lynch Syndrome Ireland 