Chemoradiotherapy plus tislelizumab for mismatch repair proficient rectal cancer with supraclavicular lymph node metastasis: A case report

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Abstract

BACKGROUND

According to the latest report, colorectal cancer is still one of the most prevalent cancers, with the third highest incidence and mortality worldwide. Treatment of advanced rectal cancer with distant metastases is usually unsatisfactory, especially for mismatch repair proficient (pMMR) rectal cancer, which leads to poor prognosis and recurrence.

CASE SUMMARY

We report a case of a pMMR rectal adenocarcinoma with metastases of multiple lymph nodes, including the left supraclavicular lymph node, before treatment in a 70-year-old man. He received full courses of chemoradiotherapy (CRT) followed by 4 cycles of programmed death 1 inhibitor Tislelizumab, and a pathologic complete response (pCR) was achieved, and the lesion of the left supraclavicular lymph node also disappeared.

CONCLUSION

pMMR advanced rectal cancer with preserved intact distant metastatic lymph nodes may benefit from full-course CRT combined with immunotherapy.

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Most cited references 16

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Cancer statistics, 2023

Rebecca L Siegel, Kimberly D Miller, Nikita Sandeep Wagle … (2023)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.

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PD-1 Blockade in Tumors with Mismatch-Repair Deficiency.

Dung Le, Jennifer Uram, Hao Wang … (2015)

Somatic mutations have the potential to encode "non-self" immunogenic antigens. We hypothesized that tumors with a large number of somatic mutations due to mismatch-repair defects may be susceptible to immune checkpoint blockade.

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Comprehensive Molecular Characterization of Human Colon and Rectal Cancer

Nikolaus Schultz (2014)

Summary To characterize somatic alterations in colorectal carcinoma (CRC), we conducted genome-scale analysis of 276 samples, analyzing exome sequence, DNA copy number, promoter methylation, mRNA and microRNA expression. A subset (97) underwent low-depth-of-coverage whole-genome sequencing. 16% of CRC have hypermutation, three quarters of which have the expected high microsatellite instability (MSI), usually with hypermethylation and MLH1 silencing, but one quarter has somatic mismatch repair gene mutations. Excluding hypermutated cancers, colon and rectum cancers have remarkably similar patterns of genomic alteration. Twenty-four genes are significantly mutated. In addition to the expected APC, TP53, SMAD4, PIK3CA and KRAS mutations, we found frequent mutations in ARID1A, SOX9, and FAM123B/WTX. Recurrent copy number alterations include potentially drug-targetable amplifications of ERBB2 and newly discovered amplification of IGF2. Recurrent chromosomal translocations include fusion of NAV2 and WNT pathway member TCF7L1. Integrative analyses suggest new markers for aggressive CRC and important role for MYC-directed transcriptional activation and repression.

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Author and article information

Contributors

Wen-Tao Zhong

Yuan Lv

Qian-Yu Wang

Ran An

Gang Chen

Jun-Feng Du

Journal

Journal ID (nlm-ta): World J Gastrointest Oncol

Journal ID (publisher-id): WJGO

Title: World Journal of Gastrointestinal Oncology

Publisher: Baishideng Publishing Group Inc

ISSN (Electronic): 1948-5204

Publication date (Print): 15 May 2024

Publication date (Electronic): 15 May 2024

Volume: 16

Issue: 5

Pages: 2219-2224

Affiliations

The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China

Department of General Surgery, The 7 ^th Medical Center of PLA General Hospital, Beijing 100700, China

Department of Pathology, The 7 ^th Medical Center of PLA General Hospital, Beijing 100700, China

Department of General Surgery, The 7 ^th Medical Center of PLA General Hospital, Beijing 100700, China

Department of General Surgery, The 7 ^th Medical Center of PLA General Hospital, Beijing 100700, China. dujunfeng@ 123456301hospital.com.cn

Author notes

Co-first authors: Wen-Tao Zhong and Yuan Lv.

Co-corresponding authors: Gang Chen and Jun-Feng Du.

Author contributions: Zhong WT and Lv Y contributed to data collection, the conceptualization and drafted the manuscript; An R and Wang QY analyzed the data; Chen G and Du JF were involved in the writing, review and editing of the manuscript; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Zhong WT and Lv Y contributed equally to this work as co-first authors. The reasons are as following. This research was conducted as a collaborative effort. Zhong WT and Lv Y collaborated on the writing and data analysis of the article, they made equal and substantial efforts throughout the entire research process. The designation of their co-first authors accurately reflect the distribution of relevant responsibilities and burdens and ultimately improves the quality of the paper. Chen G and Du JF were designated as co-corresponding authors, because the entire research team is composed of researchers with different professional backgrounds, and the designation of co-corresponding authors best reflects this diversity. Chen G and Du JF participated in the writing, review and editing of the manuscript, through professional analysis and editing, the quality of the article has been significantly improved. In conclusion, our co-authors and co-corresponding authors designations are completely correct and confirmed by all authors.

Supported by National Natural Science Foundation of China, No. 81870393.

Corresponding author: Jun-Feng Du, MD, Adjunct Professor, Department of General Surgery, The 7 ^th Medical Center of PLA General Hospital, No. 5 NanmenCang, Beijing 100700, China. dujunfeng@ 123456301hospital.com.cn

Article

Other ID: jWJGO.v16.i5.pg2219 Publisher-manuscript ID: 89829

DOI: 10.4251/wjgo.v16.i5.2219

PMC ID: 11099463

PubMed ID: 38764824

SO-VID: 59120f1d-da49-4d72-be3c-090cce7725dd

License:

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

History

Date received : 14 November 2023

Date revision received : 8 February 2024

Date accepted : 14 March 2024

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Chemoradiotherapy plus tislelizumab for mismatch repair proficient rectal cancer with supraclavicular lymph node metastasis: A case report

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Abstract

BACKGROUND

CASE SUMMARY

CONCLUSION

Related collections

ScienceOpen Clinical Case Reports Collection

Most cited references 16

Cancer statistics, 2023

PD-1 Blockade in Tumors with Mismatch-Repair Deficiency.

Comprehensive Molecular Characterization of Human Colon and Rectal Cancer

Author and article information

Contributors

Journal

Affiliations

Author notes

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History

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