Challenges of neoadjuvant immunotherapy in mismatch repair-deficient/microsatellite-unstable localized colon cancer patients
- Study type
- Review article
- Design
- Review of key clinical trials of neoadjuvant or adjuvant immune checkpoint inhibitors (ICI) in non-metastatic dMMR colon cancer, with the design of a treatment algorithm
- Source
- ESMO Open · 2026
In plain words
In some patients with colon cancer, the tumour has a fault in its DNA repair system (dMMR) and can respond to immunotherapy drugs. This article reviews the trials of giving these drugs before or after surgery and proposes an algorithm (a step-by-step decision guide) to help with decision-making. According to this article, the choice of treatment depends on your clinical situation, how the tumour looks on the CT scan and the aim of treatment; this decision should be made together with the treating doctor.
Study population
Patients with non-metastatic mismatch repair-deficient (dMMR) colon cancer. The abstract gives no more detailed inclusion criteria.
Endpoints
This paper is a review and its abstract reports no specific primary or secondary endpoints.
Safety and side effects
The abstract refers only in general terms to the accumulating evidence on the efficacy and tolerability of neoadjuvant immunotherapy in dMMR colon cancer and gives no specific adverse event figures (grade ≥3).
Clinical significance and place in guidelines
Despite the accumulating evidence on the efficacy and tolerability of neoadjuvant immunotherapy in dMMR colon cancer, this paper stresses that defining its indication in routine practice is still difficult, and offers an algorithm for managing these patients. According to the abstract, the choice between neoadjuvant and adjuvant ICI depends mainly on the patient's clinical status, tumour features on baseline CT and the treatment goals. This is an algorithm proposed by the authors and should not replace formal guidelines; the status of this approach in current guidelines should be checked separately.
Limitations
The abstract does not give details of the trials reviewed, patient numbers, numerical results or algorithm details; these should be checked in the full text. The algorithm presented was designed from the authors' review and is not a formal guideline.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.