The Shift Toward Precision Immunotherapy in Bowel Cancer Care
The landscape of oncology is shifting. For years, the standard approach for stage two or three bowel cancer has been a combination of surgery followed by post-operative chemotherapy. However, recent data from the NEOPRISM-CRC trial, led by University College London (UCL) and UCLH, suggests a future where chemotherapy may no longer be the default for every patient.
The trial focused on patients with a specific genetic profile—those with MMR-deficient/MSI-high bowel cancer. Instead of traditional post-op chemotherapy, these patients received a short course of the immunotherapy drug pembrolizumab before their surgery. The results are striking: after 33 months of follow-up, zero patients in the trial experienced a return of their cancer.
The Rise of Pre-Operative Immunotherapy
One of the most significant trends emerging from this research is the move toward “neoadjuvant” therapy—treating the cancer before the surgeon ever makes an incision. In the NEOPRISM-CRC study, patients received up to nine weeks of pembrolizumab prior to surgery.
Initial findings showed that 59% of these patients had no signs of disease remaining after the immunotherapy and their planned operation. More importantly, the long-term follow-up confirmed that even those who still had small amounts of cancer remaining after treatment did not see those cells grow or spread.
This suggests that for patients with the right genetic markers, immunotherapy can provide a more lasting defense against recurrence than the traditional surgery-then-chemo pipeline.
Personalised Blood Tests and the End of “One Size Fits All”
The future of cancer treatment is not just about the drug used, but about knowing exactly who will respond to it. Researchers are now leveraging personalised blood tests and immune profiling to remove the guesswork from oncology.
By analysing blood samples, clinicians can detect tumour DNA in the bloodstream. According to Yanrong Jiang, a clinical PhD student at the UCL Cancer Institute, when this tumour DNA disappears from the blood, patients are far more likely to be cancer-free. This allows for real-time monitoring of whether a treatment is working long before traditional scans might pick up a change.
immune profiling from tumour tissue—conducted before the first cycle of treatment—can help predict how a patient will respond. This paves the way for a highly tailored approach:
- Low-risk patients: May require less therapy before and after surgery.
- High-risk patients: Can be identified early and given additional, more aggressive treatments to prevent relapse.
Biological Insights and Long-Term Survival
The success of this approach isn’t just about the statistics; it’s about the biology. Professor Marnix Jansen of the UCL Cancer Institute notes that these results provide crucial insights into why immunotherapy is so effective in this specific setting. By priming the immune system to recognize and attack the cancer before surgery, the body is better equipped to prevent the disease from returning.
While these results are “extremely encouraging,” as stated by Chief Investigator Dr Kai-Keen Shiu, the medical community is now looking toward larger studies to confirm these benefits across broader patient groups. The goal is to transition these findings from a controlled trial into a standard of care that improves long-term survival for thousands of patients.
For more information on how new drugs are changing the game, you can explore research on targeting tumour defences or the latest in immunotherapy trials.
Frequently Asked Questions
What is the NEOPRISM-CRC trial?
It is a clinical trial led by UCL and UCLH that tested whether giving the immunotherapy drug pembrolizumab before surgery, instead of chemotherapy after surgery, could prevent bowel cancer from returning in patients with a specific genetic profile.
Who is eligible for this type of immunotherapy?
The trial specifically recruited patients with stage two or three bowel cancer who have an MMR-deficient/MSI-high genetic profile.
How does this differ from standard bowel cancer treatment?
Standard treatment typically involves surgery followed by post-operative chemotherapy. This new approach uses immunotherapy before surgery to shrink tumours and prime the immune system, potentially eliminating the demand for post-op chemotherapy.
What are the long-term results of the study?
After 33 months of follow-up, none of the treated patients in the trial experienced a relapse of their cancer.
