How would you approach a clinical stage 3 sigmoid colon cancer, dMMR/MSI-H with comorbidities and increased risk of surgical complications?

For patients with dMMR/MSI-H clinical stage III sigmoid colon cancer, the current practice would be upfront surgery, and usually, most patients should be able to tolerate the minimally invasive surgical approach.

If the patient is not a surgical candidate due to comorbidities with increased risk of surgical complication, immunotherapy can be considered (if the patient does not have contraindication or ECOG performance prohibit such treatment).

There are data to support such an approach.

1. The NICHE study included 20 dMMR and 15 pMMR colon cancer patients who received a single dose of ipilimumab and 2 doses of nivolumab prior to surgery. 100% (20/20) dMMR patients had pathological response and 12 patients had pathological complete response (Cha...