Abstract
The role of palliative surgery in the management of acute complications in patients with disseminated malignancy remains controversial given the complexity of assessing acute surgical risk and long-term oncologic outcome. With the emergence of checkpoint blockade immunotherapy, there appears to be an increasing role for historically palliative procedures as a bridge to systemic immunotherapy. This is especially evident in advanced microsatellite instability-high (MSI-H) colorectal cancer where malignant obstruction and fistula formation are more common and where immunotherapy with checkpoint blockade (anti-PD-1/PD-L1, anti-CTLA-4) has a high response rate with potential for favorable oncologic outcomes. We present a series of three patients with MSI-H metastatic colorectal cancer complicated by malignant bowel obstruction and fistula formation, who having progressed on standard chemotherapy, underwent palliative intervention as a bridge to immune checkpoint blockade with durable and clinically meaningful anti-cancer responses. These cases highlight the need to re-evaluate the role of historically palliative operations in the setting of disease progression for immunotherapy-responsive tumors.
Original language | English (US) |
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Article number | 581 |
Journal | Frontiers in Oncology |
Volume | 10 |
DOIs | |
State | Published - Apr 21 2020 |
Keywords
- immunotherapy
- malignant bowel obstruction
- metastatic colorectal adenocarcinoma
- microsatellite instability high (MSI-H)
- palliative surgery
ASJC Scopus subject areas
- Oncology
- Cancer Research