Abstract
BackgroundTo evaluate the objective clinical outcomes of active specific immunotherapy (ASI) in advanced colorectal cancer (advanced CRC) and suspected minimal residual colorectal cancer (suspected minimal residual CRC).MethodsA search was conducted on Medline and Pub Med from January 1998 to January 2010 for original studies on ASI in colorectal cancer (CRC). All articles included in this study were assessed with the application of predetermined selection criteria and were divided into two groups: ASI in advanced CRC and ASI in suspected minimal residual CRC. For ASI in suspected minimal residual CRC, a meta-analysis was executed with results regarding the overall survival (OS) and disease-free survival (DFS). Regarding ASI in advanced colorectal cancer, a system review was performed with clinical outcomes.Results1375 colorectal carcinoma patients with minimal residual disease have been enrolled in Meta-analysis. A significantly improved OS and DFS was noted for suspected minimal residual CRC patients utilizing ASI (For OS: HR = 0.76, P = 0.007; For DFS: HR = 0.76, P = 0.03). For ASI in stage II suspected minimal residual CRC, OS approached significance when compared with control (HR = 0.71, P = 0.09); however, the difference in DFS of ASI for the stage II suspected minimal residual CRC reached statistical significance (HR = 0.66, P = 0.02). For ASI in stage III suspected minimal residual CRC compared with control, The difference in both OS and DFS achieved statistical significance (For OS: HR = 0.76, P = 0.02; For DFS: HR = 0.81, P = 0.03). 656 advanced colorectal patients have been evaluated on ASI in advanced CRC. Eleven for CRs and PRs was reported, corresponding to an overall response rate of 1.68%. No serious adverse events have been observed in 2031 patients.ConclusionsIt is unlikely that ASI will provide a standard complementary therapeutic approach for advanced CRC in the near future. However, the clinical responses to ASI in patients with suspected minimal residual CRC have been encouraging, and it has become clear that immunotherapy works best in situations of patients with suspected minimal residual CRC.
Highlights
To evaluate the objective clinical outcomes of active specific immunotherapy (ASI) in advanced colorectal cancer and suspected minimal residual colorectal cancer
We focused on meta-analysis of ASI to patients with suspected minimal residual colorectal cancer, and reviewed the objective clinical outcomes of ASI in advanced colorectal cancer during the past 12 years
A subgroup analysis by stage of disease, For ASI in stage II suspected minimal residual Colorectal cancer (CRC) compared with control, overall survival (OS) approached significance when compared with control (P = 0.09), The disease-free survival (DFS) of ASI reached statistical significance (P = 0.02); For ASI in stage III suspected minimal residual CRC compared with control, The difference in both OS (P = 0.02) and DFS (P = 0.03) achieved statistical significance
Summary
To evaluate the objective clinical outcomes of active specific immunotherapy (ASI) in advanced colorectal cancer (advanced CRC) and suspected minimal residual colorectal cancer (suspected minimal residual CRC). More than 20% of patients with CRC have metastatic disease at the time of diagnosis [2]. The most common indication for liver resection in developed countries is metastatic CRC, surgery can only be performed in 20% patients [3].The prognosis of patients with resectable tumor depends on the disease stage. Despite the fact that 80% of CRC patients have complete macroscopic clearance of the tumor by surgery, 50% of CRC patients will relapse [5]. This is presumably due to the presence of micro-metastasis at the time of surgery. The 5-year survival for patients with CRC ranges from 50-60% over the past 30 years [6]
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