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Pathological complete response to pembrolizumab in patients with metastatic ascending colon cancer with microsatellite instability

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Abstract

Pembrolizumab is a novel immune-checkpoint inhibitor used for treatment of microsatellite instability-high (MSI-H) colorectal cancer. Several studies have reported clinical complete response (CR) after treatment with pembrolizumab, but none has confirmed pathological CR. Here we provide the first description of pathological CR with R0 resection after immune-checkpoint therapy. A 45-year-old man presented at our hospital with abdominal distention and highly elevated tumor markers. Contrast-enhanced abdominal CT showed a 110 × 75 mm bulky mass with markedly swollen lymph nodes and an isolated peritoneal metastasis in the pelvic space. Biopsy revealed poorly differentiated adenocarcinoma. We diagnosed ascending colon cancer cT4aN2bM1c Stage IVc. A biopsy specimen obtained during systemic chemotherapy (FOLFOXIRI) was confirmed pathologically as MSI-H, after which the treatment was changed to pembrolizumab. The tumor markers rapidly decreased to within normal ranges after three courses of treatment. After twenty courses, CT revealed shrinkage of the main tumor, lymph node metastases, and the peritoneal metastasis, and we performed extended right hemi-colectomy with dissection of the peritoneal metastasis. No residual tumor cells were found histologically. The patient achieved pathological CR and the postoperative course was uneventful. An accurate diagnosis and appropriate follow up are crucial for obtaining sufficient therapeutic effect of pembrolizumab.

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Authors and Affiliations

  1. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Tetsuro Tominaga, Takashi Nonaka, Akiko Fukuda, Masaaki Moriyama, Shosaburo Oyama, Mitsutoshi Ishii & Takeshi Nagayasu

  2. Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Terumitsu Sawai

  3. Department of Pathology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Shinji Okano

Authors
  1. Tetsuro Tominaga
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  2. Takashi Nonaka
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  3. Akiko Fukuda
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  4. Masaaki Moriyama
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  5. Shosaburo Oyama
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  6. Mitsutoshi Ishii
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  7. Terumitsu Sawai
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  8. Shinji Okano
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  9. Takeshi Nagayasu
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Correspondence to Tetsuro Tominaga.

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All procedures followed were in accordance with the ethical standards of our Institutional Review Board and with the Helsinki Declaration of 1975, as revised in 2008(5).

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Informed consent was obtained from the patient for inclusion in this study.

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Tominaga, T., Nonaka, T., Fukuda, A. et al. Pathological complete response to pembrolizumab in patients with metastatic ascending colon cancer with microsatellite instability. Clin J Gastroenterol 15, 134–139 (2022). https://doi.org/10.1007/s12328-021-01543-y

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  • DOI: https://doi.org/10.1007/s12328-021-01543-y

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