Would you offer chemotherapy to an elderly patient with MSI-H stage 3 colon cancer who cannot tolerate oxaliplatin?

The current NCCN guidelines already incorporated the ATOMIC study data and added CAPOX or FOLFOX with atezolimumab in addition to CAPOX or FOLFOX as preferred regimens for resected dMMR stage III colon cancer, while still listing single-agent fluoropyrimidine as an option.

The interesting part to me ...

This is a great (and timely) question that is not easy to answer due to insufficient high-quality data. I approach these cases based on the following principles:

1. For patients ineligible to receive oxaliplatin, adjuvant 5-FU therapy alone is inadequate and possibly detrimental in this patient popul...

MMR deficiency is among the best predictive biomarkers for immunotherapy efficacy. While chemotherapy has very limited efficacy in dMMR colorectal cancer patients, the efficacy of neoadjuvant immunotherapy is remarkable, with very high pCR rates across many studies utilizing immunotherapy alone. Neo...

NICHE-2 should move the Rx paradigm to neoadjuvant in dMMR colon cancer if the CT staging is reliable enough:

• One dose of ipilimumab (1 mg/kg) on day 1
• Two doses of nivolumab (3 mg/kg) on day 1 and day 15, and done!