文献类型：期刊文献

英文题名：Neoadjuvant therapy for pMMR/MSS locally advanced rectal cancer in the immunotherapy era: current landscape and future perspectives

作者：Farooq, Benish[1];Li, Xingyu[2];Xiao, Sa[3];Liu, Xiaojun[4,5,6]

第一作者：Farooq, Benish

通信作者：Liu, XJ[1];Liu, XJ[2];Liu, XJ[3]

机构：[1]Lanzhou Univ, Sch Life Sci, Lanzhou, Peoples R China;[2]Gansu Univ Chinese Med, Sch Clin Med 1, Lanzhou, Peoples R China;[3]Lanzhou Univ, Coll Ecol, State Key Lab Herbage Improvement & Grassland Agro, Lanzhou, Peoples R China;[4]Gansu Prov Hosp, Div Radiat Oncol, Lanzhou, Peoples R China;[5]Lanzhou Univ, Hosp 3, Lanzhou, Peoples R China;[6]Lanzhou Univ, Clin Med Sch, Lanzhou, Peoples R China

第一机构：Lanzhou Univ, Sch Life Sci, Lanzhou, Peoples R China

通信机构：[1]corresponding author), Gansu Prov Hosp, Div Radiat Oncol, Lanzhou, Peoples R China;[2]corresponding author), Lanzhou Univ, Hosp 3, Lanzhou, Peoples R China;[3]corresponding author), Lanzhou Univ, Clin Med Sch, Lanzhou, Peoples R China.

年份：2025

卷号：15

外文期刊名：FRONTIERS IN ONCOLOGY

收录：;Scopus(收录号：2-s2.0-105025124969);WOS:【SCI-EXPANDED(收录号:WOS:001639799200001)】；

基金：The author(s) declare that financial support was received for the research and/or publication of this article. This study was supported by Gansu Provincial Joint Research Fund (No. 24JRRA891).

语种：英文

外文关键词：rectal cancer; pMMR/MSS; immunotherapy; watch and wait approach; pathological complete regression; clinical complete remission; long-course chemoradiotherapy; short-course chemoradiotherapy

摘要：Numerous clinical studies indicate that neoadjuvant chemoradiotherapy (NCRT) with immunotherapy can significantly increase pathological complete response (pCR) and clinical complete response (cCR) rates to over 30-60%, substantially higher than the 15-20% observed with conventional NCRT. This allows more patients to become eligible for a Watch-and-Wait (WW) strategy, successfully preserving organ function. Several phase III randomized controlled trials (RCTs) are currently underway. The combination of NCRT and immunotherapy holds promise for breaking the therapeutic impasse in proficient mismatch repair/microsatellite stability (pMMR/MSS) rectal cancer, markedly enhancing tumor regression and the potential for organ preservation. However, challenges remain for NCRT combined with immunotherapy in this population. First of all, there is an unmet need to identify predictive biomarkers for treatment response in pMMR/MSS rectal cancer. Next, treatment protocols require further optimization, specifically in determining the best radiotherapy fractionation schedule, its sequencing with immunotherapy, and the radiotherapy target volume. Otherwise, the phenomenon of "pseudo-residual disease" complicates traditional radiological assessment of cCR and must be overcome. Furthermore, the long-term survival benefits of combining radiotherapy with immunotherapy need further confirmation. This review provided a comprehensive and in-depth view of immunotherapy-based NCRT (iNCRT) in patients with pMMR/MSS rectal cancer and discuss the new opportunities and challenges this strategy presents for achieving organ preservation.