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Pre-surgery immunotherapy kept bowel cancer patients cancer-free for nearly three years

Pre-surgery immunotherapy kept bowel cancer patients cancer-free for nearly three years

New Capabilities

In the NEOPRISM-CRC trial, none of 32 patients with MMR-deficient bowel cancer relapsed after pembrolizumab before surgery instead of post-operative chemotherapy.

Today: ScienceDaily reports the durable outcomes

Overview

Updated 1 hour ago

A short course of immunotherapy before surgery kept every patient with a specific form of bowel cancer free of recurrence for nearly three years. In the NEOPRISM-CRC trial, 32 patients with MMR-deficient bowel cancer received pembrolizumab for up to nine weeks before surgery, instead of the usual post-operative chemotherapy.

None of the 32 relapsed in 33 months. That includes patients who still had traces of cancer after treatment; those remnants did not grow or spread. Standard surgery-plus-chemotherapy carries about a 25% three-year relapse rate for this group.

Why it matters

If confirmed, pre-surgery immunotherapy could replace post-operative chemotherapy for thousands of UK bowel cancer patients and cut their three-year relapse risk.

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Key Indicators

0
Cancer recurrences
None of 32 NEOPRISM-CRC patients relapsed in 33 months of follow-up.
32
Trial patients
Stage 2-3 MMR-deficient bowel cancer patients treated at five UK hospitals.
59%
No detectable cancer after treatment
Share of patients with no cancer detectable after immunotherapy and surgery.
~25%
Standard-care 3-year relapse rate
Expected relapse rate for surgery followed by chemotherapy, used as the trial comparison.

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Timeline

2023 October 2026

4 events Latest: Today
Tap a bar to jump to that date
  1. ScienceDaily reports the durable outcomes

    Today Coverage

    ScienceDaily publishes report on zero recurrences, including patients with residual disease.

  2. Zero relapses presented at AACR meeting

    Results

    Researchers report none of 32 patients relapsed after 33 months of follow-up.

  3. Christopher's surgery marks tumor response

    Treatment

    Patient undergoes surgery after nine weeks of pembrolizumab; doctors say cancer melted away.

  4. NEOPRISM-CRC trial enrolls 32 patients

    Trial

    Patients with MMR-deficient stage 2-3 bowel cancer join the trial at five UK hospitals.

Scenarios

1

NHS approves pre-surgery pembrolizumab for MMR-deficient bowel cancer

Likely Resolves by Q2 2028

Discussed by: UCL and UCLH researchers, BBC News reporting on hopes the treatment reaches the NHS in coming years

NICE appraises neoadjuvant pembrolizumab for MMR-deficient stage 2-3 bowel cancer. If approved, pre-surgery immunotherapy becomes the standard first step, replacing surgery-then-chemo for this patient group. UCL and UCLH researchers said they hope it reaches the NHS in the coming years.

2

Larger trial confirms the durable benefit

Possible Resolves by End of 2029

Discussed by: Researchers cautioning the current trial is small with a short follow-up; Prof Jim Khan on the need for tailored approaches

A phase 3 trial with more patients and longer follow-up reports recurrence or survival outcomes. Results either confirm the zero-relapse finding or narrow it once a larger, more diverse group is studied. Researchers say the current evidence needs validation at scale.

3

Immunotherapy benefit stays limited to MMR-deficient patients

Possible Resolves by End of 2028

Discussed by: BBC News reporting on patient Elise Sargent with a different mutation; Prof Jim Khan on tailoring treatment to tumor biology

The zero-relapse result applies only to the 10-15% of stage 2-3 bowel cancer patients with MMR-deficient tumors. National guidelines keep pre-surgery immunotherapy limited to this group, and patients with other genetic profiles continue with standard chemotherapy options.

Historical Context

2 moments from history that rhyme with this story — and how they unfolded.

May 2017

FDA approves pembrolizumab for MSI-high cancers (2017)

The US Food and Drug Administration approved pembrolizumab for any solid tumor with microsatellite instability-high or mismatch-repair-deficient features. It was the first approval tied to a genetic marker rather than tumor location.

Then

Patients with these mutations gained a drug effective across multiple cancer types, not just one.

Now

Established MMR deficiency as a predictive biomarker for immunotherapy, laying the foundation for trials like NEOPRISM-CRC.

Why this matters now

The same genetic profile selected patients for this bowel cancer trial — the marker predicted who would respond to the drug.

May 2022

CheckMate 816 neoadjuvant lung cancer trial (2022)

A phase 3 trial showed nivolumab plus chemotherapy before surgery improved event-free survival in resectable non-small-cell lung cancer, versus chemotherapy alone.

Then

Became a new standard option for resectable lung cancer patients.

Now

Encouraged pre-surgical immunotherapy across tumor types, including the design NEOPRISM-CRC later tested in bowel cancer.

Why this matters now

Provided the precedent for giving immunotherapy before surgery rather than after — the approach this trial applied to MMR-deficient bowel cancer.

Sources

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