早期结肠癌管理的未来机遇。
Opportunities on the horizon for the management of early colon cancer.
作者信息
Knapen Daan G, de Haan Jacco J, Fehrmann Rudolf S N, de Vries Elisabeth G E, de Groot Derk Jan A
机构信息
Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
出版信息
Crit Rev Oncol Hematol. 2023 Mar;183:103918. doi: 10.1016/j.critrevonc.2023.103918. Epub 2023 Jan 23.
There is a clear unmet need to improve early colon cancer management. This review encompasses the current systemic treatment landscape and summarises novel and pivotal trials. The Immunoscore and circulating tumour DNA (ctDNA) are studied to evaluate which patients should receive no, 3, or 6 months of adjuvant treatment. Several trials also test escalating treatment strategies for non-cleared ctDNA following standard adjuvant chemotherapy. Advances made in treating patients with metastatic colon cancer are now being translated to the early colon cancer setting. Two ongoing RCTs study immune checkpoint inhibitors (ICI) in patients with microsatellite instable high (MSI-H) early colon cancer as adjuvant treatment. Neo-adjuvant treatment is being studied in several ongoing RCTs as well. The complete response rate in patients with MSI-H tumours following ICI in neoadjuvant trials has potential organ-sparing implications.
改善早期结肠癌的治疗存在明显未被满足的需求。本综述涵盖了当前的全身治疗情况，并总结了新的关键试验。对免疫评分和循环肿瘤DNA（ctDNA）进行了研究，以评估哪些患者应接受0、3或6个月的辅助治疗。多项试验还测试了标准辅助化疗后ctDNA未清除患者的强化治疗策略。转移性结肠癌治疗方面取得的进展目前正被应用于早期结肠癌的治疗。两项正在进行的随机对照试验研究免疫检查点抑制剂（ICI）作为微卫星高度不稳定（MSI-H）早期结肠癌患者的辅助治疗。新辅助治疗也在多项正在进行的随机对照试验中进行研究。新辅助试验中ICI治疗后MSI-H肿瘤患者的完全缓解率对器官保留具有潜在意义。
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