Genomics and emerging biomarkers for immunotherapy of colorectal cancer

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

  • Jakob Nikolas Kather - , Heidelberg University , German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelberg (Author)
  • Niels Halama - , Heidelberg University , German Cancer Research Center (DKFZ) (Author)
  • Dirk Jaeger - , Heidelberg University , German Cancer Research Center (DKFZ) (Author)

Abstract

Colorectal cancer (CRC) is a common and lethal disease with a high therapeutic need. For most patients with metastatic CRC, chemotherapy is the only viable option. Currently, immunotherapy is restricted to the particular genetic subgroup of mismatch-repair deficient (MMRd)/microsatellite instable (MSI) CRC. Anti-PD1 therapy was recently FDA-approved as a second-line treatment in this subgroup. However, in a metastatic setting, these MMRd/MSI tumors are vastly outnumbered by mismatch-repair proficient (MMRp)/microsatellite stable (MSS) tumors. These MMRp/MSS tumors do not meaningfully respond to any traditional immunotherapy approach including checkpoint blockade, adoptive cell transfer and vaccination. This resistance to immunotherapy is due to a complex tumor microenvironment that counteracts antitumor immunity through a combination of poorly antigenic tumor cells and an immunosuppressive tumor microenvironment. To find ways of overcoming immunotherapy resistance in the majority of CRC patients, it is necessary to analyze the immunological makeup in an in-depth and personalized way and in the context of their tumor genetic makeup. Flexible, biomarker-guided early-phase immunotherapy trials are needed to optimize this workflow. In this review, we detail key mechanisms for immune evasion and emerging immune biomarkers for personalized immunotherapy in CRC. Also, we present a template for biomarker-guided clinical trials that are needed to move new immunotherapy approaches closer to clinical application.

Details

Original languageEnglish
Pages (from-to)189-197
Number of pages9
JournalSeminars in cancer biology
Volume52
Publication statusPublished - Oct 2018
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 29501787

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • Biomarker, Clinical trials, Colorectal cancer, Genomics, Immunotherapy, Personalized medicine, Tumor microenvironment