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Cirugía Española (English Edition) The current status of immunotherapy in colorectal cancer: A systematic review
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Vol. 103. Issue 11.
(November 2025)
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Vol. 103. Issue 11.
(November 2025)
Systematic review
The current status of immunotherapy in colorectal cancer: A systematic review
Estado actual de la inmunoterapia en el tratamiento del cáncer colorrectal: Revisión sistemática.
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Hanna Cholewaa, Pablo Guerrero-Antolinoa, David Quevedoa, Jorge Sancho-Muriela,
Corresponding author
jsanchomuriel@gmail.com

Corresponding author.
, Matteo Frassona,b, Blas Flor-Lorentea
a Colorectal Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b University of Valencia, Valencia, Spain
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Table 1. Neoadjuvant immunotherapy – study, treatment and patient characteristics (NR – not reported).
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Table 2. Neoadjuvant immunotherapy – outcomes (NR – not reported).
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Table 3. Adjuvant immunotherapy – study, treatment and patient charateristics (prior systemic treatment, age, sex and MSI status; NR – not reported).
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Table 4. Adjuvant immunotherapy – tumour characteristics and outcomes (NR – not reported).
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Table 5. Metastatic setting immunotherapy – study and treatment characteristics (NR – not reported).
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Table 6. Metastatic setting immunotherapy - patient characteristics and outcomes (NR – not reported).
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Abstract

The following systematic review aimed to present the current status of immunotherapy in colorectal cancer, in the neoadjuvant, adjuvant and metastatic setting. Pubmed, Cochrane and Embase databases were searched up to April 2024 and the PICO framework, as well as the following inclusion criteria (clinical studies in English published ≥2000 per year, both retrospective and prospective, including abstracts from relevant congresses, yet excluding case reports, letters, phase I clinical trials and radioimmunotherapy) were applied. MINORS and RoB2 were used to assess quality and risk of bias. Due to heterogeneity of the studies, a descriptive analysis was performed. In total, 99 studies (including 11 226 patients) were analysed, concluding that immunotherapy application, although encouraging, still needs refinement, most importantly in terms of patient and treatment regimen selection. The review was registered on the PROSPERO platform (ID: CRD42023417537) and funded by a grant by the Spanish Association of Surgery (AEC).

Keywords:
Immunotherapy
Colorectal cancer
Immune checkpoint inhibitors
Microsatellite instability
Resumen

El objetivo de esta revisión sistemática es presentar el estado actual de la inmunoterapia en el tratamiento del cáncer colorrectal, tanto de forma neoadyuvante, adyuvante, como en entorno metastásico. Se incluyeron trabajos registrados en Pubmed, Cochrane y Embase, publicados en inglés entre 2000 y abril 2024, incluyendo abstracts de congresos. Se han excluido series de casos, cartas, ensayos clínicos fase I y estudios sobre radioinmunoterapia. La calidad de los estudios y el riesgo de sesgos se han evaluado mediante MINORS y RoB2. Debido a la heterogeneidad de los estudios se ha realizado un análisis descriptivo. Se analizaron 99 estudios (total de 11226 pacientes), concluyendo que la aplicación de la inmunoterapia, aunque alentadora, todavía precisa de una mayor evidencia en cuanto a la selección de pacientes y de esquemas de tratamiento. La revisión se ha registrado en PROSPERO (ID: CRD42023417537) y ha recibido financiación de la Asociación Española de Cirujanos.

Palabras clave:
Inmunoterapia
Cáncer colorrectal
Inhibidores de puntos de control inmunitario
Inestabilidad de microsatelites
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