Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab

Preoperative chemotherapy is efficacious in several cancers. However, it is not an established treatment for locally advanced colon cancer, particularly cases with microsatellite instability-high (MSI-H)/deficient mismatch repair. Herein, we report a case of pathological complete response of MSI-H c...

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Autores principales:	Terufumi Yoshida, Hisanori Miki, Hironaga Satake, Toshinori Kobayashi, Yuuki Matsumi, Madoka Hamada, Shogen Boku, Nobuhiro Shibata, Mitsuaki Ishida, Mitsugu Sekimoto
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	pembrolizumab preoperative chemotherapy colon cancer microsatellite instability-high dmmr complete response Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/e7a84401824a45099d4f19737302b62b
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spelling	oai:doaj.org-article:e7a84401824a45099d4f19737302b62b2021-11-18T11:08:46ZPathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab1662-657510.1159/000519470https://doaj.org/article/e7a84401824a45099d4f19737302b62b2021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519470https://doaj.org/toc/1662-6575Preoperative chemotherapy is efficacious in several cancers. However, it is not an established treatment for locally advanced colon cancer, particularly cases with microsatellite instability-high (MSI-H)/deficient mismatch repair. Herein, we report a case of pathological complete response of MSI-H clinical T4b ascending colon cancer to preoperative treatment with pembrolizumab. A 78-year-old man was diagnosed with ascending colon cancer that invaded into the iliacus muscle and enlarged regional lymph nodes. The tumor was classified as T4bN1bM0 stage IIIC according to the 8th Union for International Cancer Control guidelines, with MSI-H status. Based on our initial diagnosis, this tumor could not be resected completely. Thus, the patient underwent preoperative therapy with CAPOX (capecitabine and oxaliplatin combination) plus bevacizumab. After 4 cycles of preoperative CAPOX/bevacizumab, we observed tumor reduction corresponding to a partial response based on the Response Evaluation Criteria in Solid Tumors criteria. Nevertheless, tumor invasion of the iliacus muscle persisted. Since oxaliplatin-induced peripheral sensory neuropathy was observed, we discontinued treatment with oxaliplatin and changed the regimen to pembrolizumab in anticipation of the therapeutic effect of this immune checkpoint inhibitor against MSI-H tumors. After 2 cycles of therapy with pembrolizumab (200 mg/body on day 1 every 3 weeks), there was drastic tumor regression. In addition, computed tomography indicated that all lymph node metastases had disappeared. Therefore, the patient underwent laparoscopic right hemicolectomy with D3 lymph node dissection. Analysis of the resected specimen showed pathological complete response.Terufumi YoshidaHisanori MikiHironaga SatakeToshinori KobayashiYuuki MatsumiMadoka HamadaShogen BokuNobuhiro ShibataMitsuaki IshidaMitsugu SekimotoKarger Publishersarticlepembrolizumabpreoperative chemotherapycolon cancermicrosatellite instability-highdmmrcomplete responseNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCase Reports in Oncology, Vol 14, Iss 3, Pp 1497-1504 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pembrolizumab preoperative chemotherapy colon cancer microsatellite instability-high dmmr complete response Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	pembrolizumab preoperative chemotherapy colon cancer microsatellite instability-high dmmr complete response Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Terufumi Yoshida Hisanori Miki Hironaga Satake Toshinori Kobayashi Yuuki Matsumi Madoka Hamada Shogen Boku Nobuhiro Shibata Mitsuaki Ishida Mitsugu Sekimoto Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab
description	Preoperative chemotherapy is efficacious in several cancers. However, it is not an established treatment for locally advanced colon cancer, particularly cases with microsatellite instability-high (MSI-H)/deficient mismatch repair. Herein, we report a case of pathological complete response of MSI-H clinical T4b ascending colon cancer to preoperative treatment with pembrolizumab. A 78-year-old man was diagnosed with ascending colon cancer that invaded into the iliacus muscle and enlarged regional lymph nodes. The tumor was classified as T4bN1bM0 stage IIIC according to the 8th Union for International Cancer Control guidelines, with MSI-H status. Based on our initial diagnosis, this tumor could not be resected completely. Thus, the patient underwent preoperative therapy with CAPOX (capecitabine and oxaliplatin combination) plus bevacizumab. After 4 cycles of preoperative CAPOX/bevacizumab, we observed tumor reduction corresponding to a partial response based on the Response Evaluation Criteria in Solid Tumors criteria. Nevertheless, tumor invasion of the iliacus muscle persisted. Since oxaliplatin-induced peripheral sensory neuropathy was observed, we discontinued treatment with oxaliplatin and changed the regimen to pembrolizumab in anticipation of the therapeutic effect of this immune checkpoint inhibitor against MSI-H tumors. After 2 cycles of therapy with pembrolizumab (200 mg/body on day 1 every 3 weeks), there was drastic tumor regression. In addition, computed tomography indicated that all lymph node metastases had disappeared. Therefore, the patient underwent laparoscopic right hemicolectomy with D3 lymph node dissection. Analysis of the resected specimen showed pathological complete response.
format	article
author	Terufumi Yoshida Hisanori Miki Hironaga Satake Toshinori Kobayashi Yuuki Matsumi Madoka Hamada Shogen Boku Nobuhiro Shibata Mitsuaki Ishida Mitsugu Sekimoto
author_facet	Terufumi Yoshida Hisanori Miki Hironaga Satake Toshinori Kobayashi Yuuki Matsumi Madoka Hamada Shogen Boku Nobuhiro Shibata Mitsuaki Ishida Mitsugu Sekimoto
author_sort	Terufumi Yoshida
title	Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab
title_short	Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab
title_full	Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab
title_fullStr	Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab
title_full_unstemmed	Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab
title_sort	pathological complete response of clinical t4b ascending colon cancer after preoperative chemotherapy using pembrolizumab
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/e7a84401824a45099d4f19737302b62b
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Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab

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