Efficacy and risk analysis of monotherapy and dual immunotherapy in dMMR/MSI-H metastatic colorectal cancer: a meta-analysis based on randomized controlled trials.
Summary
This meta-analysis assessed the efficacy and safety of single-agent versus dual immunotherapy for metastatic colorectal cancer (mCRC) with DNA mismatch repair deficiency (dMMR) or high microsatellite instability (MSI-H). PD-1/PD-L1 monotherapy significantly improved objective response rate (ORR) compared to chemotherapy, demonstrating a favorable safety profile. Dual immunotherapy (nivolumab plus ipilimumab) showed a superior ORR over monotherapy, but with increased toxicity. Benefits in progression-free survival (PFS) and overall survival (OS) were not consistently statistically significant across trials.
Analysis
This meta-analysis provides crucial data for clinical decision-making in the treatment of dMMR/MSI-H mCRC, confirming the superior efficacy of immune checkpoint inhibitors over chemotherapy and highlighting the importance of dMMR/MSI-H status testing. The study underscores a trade-off between the increased efficacy of dual immunotherapy and its higher toxicity risk, necessitating a personalized risk-benefit assessment for each patient. The findings also suggest the need for further research into biomarkers to better select patients and optimize therapeutic strategies.