PDF(Pubmed)
Abstract：
Patients with chemo-refractory metastatic colorectal cancer (mCRC) have poor prognoses. The application of programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors encouragingly improved the survival of mCRC patients with microsatellite instability-high (MSI-H)/mismatch repair-deficient (dMMR). Unfortunately, it was ineffective for mCRC with microsatellite-stable (MSS)/proficient mismatch repair (pMMR), which accounted for 95% of mCRC. Radiotherapy can promote local control by directly killing tumor cells and inducing positive immune activities, which might help synergistically with immunotherapy. We present the report of an advanced MSS/pMMR mCRC patient who had progressive disease (PD) after first-line chemotherapy, palliative surgery and second-line chemotherapy combined with targeted therapy. Then the patient received the therapy of PD-1 inhibitor combined with radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF). According to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST1.1), the patient showed a complete response (CR) after triple-combined therapy with progression-free survival (PFS) for more than 2 years so far. The patient had no other significant adverse reactions except for fatigue (Grade 1). The triple-combination therapy provided a promising strategy for metastatic chemo-refractory MSS/pMMR mCRC patients.
摘要：
化疗难治性转移性结直肠癌（mCRC）患者预后较差。程序性细胞死亡蛋白1（PD-1）/程序性细胞死亡配体1（PD-L1）抑制剂的应用令人鼓舞地改善了具有微卫星不稳定性高（MSI-H）/错配修复缺陷（dMMR）的mCRC患者的生存率。不幸的是,对于具有微卫星稳定（MSS）/熟练错配修复（PMMR）的mCRC无效，占mCRC的95%。放疗可通过直接杀伤肿瘤细胞和诱导阳性免疫活性来促进局部控制,这可能有助于与免疫疗法协同作用。我们介绍了一名晚期MSS/pMMRmCRC患者的报告，该患者在一线化疗后患有进行性疾病（PD），姑息性手术和二线化疗联合靶向治疗。随后患者接受PD-1抑制剂联合放疗和粒细胞-巨噬细胞集落刺激因子(GM-CSF)治疗。根据实体瘤1.1版（RECIST1.1）的反应评估标准，到目前为止,患者在三联疗法治疗后出现完全缓解(CR),且无进展生存期(PFS)超过2年.患者除疲劳（1级）外，无其他明显不良反应。三联疗法为转移性化学难治性MSS/pMMRmCRC患者提供了有希望的策略。
