随机 METIMMOX 试验 (NCT03388190) 检查了先前未经治疗、不可切除的微卫星稳定 (MSS) 结直肠癌 (CRC) 腹部转移患者是否可能受益于潜在免疫原性、基于奥沙利铂的短程化疗与免疫检查点阻断 (ICB) 的交替治疗。 。接受该实验治疗的 38 名患者中，有 3 名患有 BRAF 突变型 MSS-CRC 转移，一般来说，这是一个预后不良的亚组。 ≥70 岁的女性患有具有中等肿瘤突变负荷（每兆碱基 6.2-11.8 个突变）的升结肠腺癌。所有患者都经历了原发肿瘤的早期消失，随后所有明显转移性疾病的完全缓解，导致无进展生存期长达 20-35 个月。然而，他们在以前未受影响的部位和最终的庇护器官中遇到了复发，或者因为肝内肿瘤的演变反映在肝转移中最初诱导的 T 细胞克隆性的最终丧失。然而，以奥沙利铂为基础的短程化疗与 ICB 交替的一线治疗效果显着，可能为特别难以治疗的 MSS-CRC 亚组提供一种新的治疗选择。© 2024 作者。由泰勒授权出版

The randomized METIMMOX trial (NCT03388190) examined if patients with previously untreated, unresectable abdominal metastases from microsatellite-stable (MSS) colorectal cancer (CRC) might benefit from potentially immunogenic, short-course oxaliplatin-based chemotherapy alternating with immune checkpoint blockade (ICB). Three of 38 patients assigned to this experimental treatment had metastases from BRAF-mutant MSS-CRC, in general a poor-prognostic subgroup explored here. The ≥70-year-old females presented with ascending colon adenocarcinomas with intermediate tumor mutational burden (6.2-11.8 mutations per megabase). All experienced early disappearance of the primary tumor followed by complete response of all overt metastatic disease, resulting in progression-free survival as long as 20-35 months. However, they encountered recurrence at previously unaffected sites and ultimately sanctuary organs, or as intrahepatic tumor evolution reflected in the terminal loss of initially induced T-cell clonality in liver metastases. Yet, the remarkable first-line responses to short-course oxaliplatin-based chemotherapy alternating with ICB may offer a novel therapeutic option to a particularly hard-to-treat MSS-CRC subgroup.© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.