Clinical Oncology

[Why don’t immune checkpoint inhibitors work in colorectal cancer?]

SHI Yuequan, ZOU Zifang, KERR David

MAY 10, 2017

Clinical Oncology - 2017;4(02)

[In recent years, immune checkpoint inhibitors have been shown to be effective in treating manifold types of cancer but less robust in colorectal cancer (CRC). While, the subgroup of CRC with microsatellite instability (MSI; also termed as mismatch repair defi cient) showed a moderate response to Pembrolizumab in a single arm phase II clinical trial, microsatellite stable (MSS) cancers were unresponsive. Possible mechanisms that affect immune response in colorectal cancer will be reviewed in this article. We will also propose that histone deacetylase (HDAC) inhibition may reverse the immune editing commonly seen in advanced CRC and render them sensitive to immune checkpoint blockade.]

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Further articles in this publication

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[Foreword]

A szerkesztők

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[News from the World]

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[Geriatric oncology has an increasing role since in several types of cancer the median age at diagnosis is above 60 years of age. The treatment of elderly patients are frequently set back by prejudice, stereotypes and lack of information. All these lead to the fact that even in well-developed countries elderly cancer patients often do not receive the necessary treatments. This is even more true in poor-countries, where the fi nancial defi cit accumulated in health care is often attempted to be reduced by the treatment of elderly. If a paediatric oncology patient does not get suffi cient cancer treatment there is a fi erce protest, but everybody is silent if this occurs in the case of an 80 years old patient. For this unacceptable situation both authorities (fi nancing) and professional bodies (treatment, education) are responsible. Clinical data show that elderly cancer patients get the same benefi t of active oncology treatment, as younger ones. Age on its own does not contraindicate any cancer treatment. The aim of this review is to prove by data, that elderly cancer patients should also get active oncology treatment. The questions of assessment include frailty, the relationship of cancer development and ageing, and other problems related to the oncology treatment of elderly patients are also discussed.]

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[Increasing experimental and clinical evidences demonstrated the synergic effect between the rapidly implemented immunotherapy and advanced forms of focal radiotherapy, not only on the elimination of the irradiated lesion, but also on the enhancement the immune-mediated systemic anti-tumoral activity. It is essential for gaining the most benefi t from the combination of the two modalities to select the appropriate patients, to defi ne the irradiation parameters, such as radiation quality (ie. particle) dosage, (total dose, fraction number) size of the target volume, the use of other supportive and anti-tumor drugs. In this review, we provide an update for the daily oncological practice on the data accumulated up to now on the molecular basis and patomechanism of enhancing radio-immune effect and clinical results, and highlight the most important parameters, which may increase the abscopal effect of ionizing radiation, thereby increasing the effectiveness of immunotherapy. However, development of clinical guidelines for benefi cial integration of immunotherapy and radiotherapy could be expected after evaluation the result of currently ongoing numerous (> 100) clinical trials. If the preclinical results will be confi rmed clinically, it could lead to paradigm shift in the use of ionizing radiation.]

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