Keypoints:
• The significance of MSI-high status in colorectal cancer and its prevalence.
• The study design and key findings of CheckMate 8HW, including the impressive progression-free survival rates.
• The comparison of dual checkpoint inhibitors versus single-agent therapies and chemotherapy.
• Important side effects associated with the combination therapy and how to manage them.
• Insights on patient selection for immunotherapy, including considerations for age and comorbidities.
• The potential future of immunotherapy in treating not just MSI-high but also MSS colorectal cancer.
In this episode of the Oncology Brothers podcast, Drs. Rahul & Rohit Gosain had the pleasure of speaking with Dr. Nicholas Hornstein, a GI medical oncologist from Northwell Health. We delved into the recent FDA approval of the combination of nivolumab and ipilimumab for treating metastatic colorectal cancer with MSI-high or MMR-deficient disease, based on the CheckMate 8HW study.
Dr. Hornstein provided valuable insights into the significance of being MSI-high, explaining that this condition is found in about 3-5% of metastatic colorectal cancer cases, with higher prevalence in earlier stages. We discussed the various methods for detecting MSI status, including immunohistochemistry (IHC) and next-generation sequencing (NGS).
The CheckMate 8HW study was highlighted as a pivotal trial that demonstrated the efficacy of dual checkpoint inhibitors. Dr. Hornstein walked us through the study design, which compared nivolumab plus ipilimumab against nivolumab alone and against chemotherapy. The results showed a remarkable improvement in progression-free survival, with the combination therapy offering significant benefits over single-agent treatment.
We also touched on the important side effects associated with the combination therapy, including fatigue, diarrhea, and more severe immune-related adverse events. Dr. Hornstein emphasized the need for careful patient selection and shared decision-making, especially when considering treatment for older patients or those with comorbidities.
As we wrapped up, we reflected on the exciting potential of immunotherapy in oncology, not just for MSI-high colorectal cancer but also for other cancer types. We look forward to future studies that may further enhance our understanding and application of these therapies.
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