Two years ago, internist-oncologist Myriam Chalabi and her colleagues saw an unprecedentedly good result of immunotherapy in 20 colorectal cancer patients. All of those patients had microsatellite-unstable colorectal cancer (MSI), in which there are an extraordinary number of mutations in the tumor cells. Of all patients with non-metastatic colorectal cancer, 15 percent have this microsatellite-unstable form. Chalabi: “All 20 patients benefited from the treatment, something we had never seen before.”
No living cancer cell
And so there was a larger follow-up study, of which Chalabi will present the first results at the European congress. Also in this study (NICHE-2) you cannot ignore the results: the 107 patients with MSI colorectal cancer who have been treated almost all respond very well to the pre-treatment with immunotherapy. In 95 percent of patients, less than 10 percent of the cancer cells were left when they went under the knife. In two-thirds of the patients, there was not even a living cancer cell left at that time. They all received two courses of immunotherapy in the month before surgery (nivolumab and ipilimumab).
Unprecedented results
“To date, no patient has seen a recurrence of the disease, while it was largely high-risk tumors,” Chalabi said. The treatment for them is between 2 and 61 months in the past. “The results are unprecedented. It is always so special to hear when someone’s cancer is gone. Both the effect and the side effects are much better than, for example, chemotherapy prior to surgery, to which only 1 in 20 patients respond.”
Follow-up study
The treatment is currently not available to patients in the Netherlands. “This extension of the NICHE study aims to make the treatment available to all patients, and we are already working hard on that. In addition, a follow-up study will soon start at the Antoni van Leeuwenhoek among 60 patients, with a slightly different combination of immunotherapy.”
The results have not gone unnoticed abroad. “Based on our data, they are looking for ways to use this treatment in other countries, for example by setting up a comparative study themselves.”
omit operation
Also in patients with other types of cancer, such as skin cancer, doctors see good results from the pre-treatment, which is called neoadjuvant immunotherapy. Chalabi: “We are getting closer and closer to the point that we no longer have to give chemotherapy to patients who respond well to neoadjuvant immunotherapy after surgery. And eventually we hope to be able to omit surgery in patients who respond well.”
By: National Care Guide