Immunotherapy for Colorectal Cancer

Immunotherapy is a type of treatment that uses certain parts of a person’s immune system to fight diseases such as cancer.

hero symbol

The goal of immunotherapy for colorectal cancer is to boost a patient’s immune reaction to the cancer cells, allowing them to fight the disease more effectively. 

Immunotherapy for Colorectal Cancer

Immunotherapy has only been shown to be effective in a small subset of colorectal cancer patients. Specifically, patients with certain biomarkers (microsatellite-instability or mismatch repair deficiency) have recently been approved for the treatment pembrolizumab. 

Checkpoint inhibitors are an important type of immunotherapy used to treat colorectal cancer. Learn more about the basics of immunotherapy.

Immunotherapy Options

Pembrolizumab (Keytruda®)

Pembrolizumab targets PD-1, a receptor (a molecule inside or on the surface of a cell that binds to a specific substance and causes a specific effect in the cell) on tumor cells, preventing the tumor cells from hiding from the immune system. Pembrolizumab is used to treat unresectable (surgery is not an option) or metastatic colorectal cancers that have a molecular feature called microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). 

Nivolumab (Opdivo®)

Nivolumab is used to treat people who are 12 or older and have MSI-H or dMMR metastatic colorectal cancer that has grown or spread after treatment with chemotherapy with a fluoropyrimidine (such as capecitabine and fluorouracil), oxaliplatin, and irinotecan.

Dostarlimab (Jemperli®)

Dostarlimab is a PD-1 immune checkpoint inhibitor (a type of drug that blocks proteins called checkpoints that are made by some types of immune system cells, such as T cells, and some cancer cells. These checkpoints help keep immune responses from being too strong and sometimes can keep T cells from killing cancer cells. When these checkpoints are blocked, T cells can kill cancer cells better. It may be used to treat recurrent or metastatic colorectal cancers that have dMMR.

Nivolumab and ipilimumab (Yervoy®) combination

This combination of checkpoint inhibitors is approved to treat patients who are 12 or older and have MSI-H or dMMR metastatic colorectal cancer that has grown or spread after treatment with chemotherapy with a fluoropyrimidine, oxaliplatin, and irinotecan.

Side Effects of Immunotherapies

Different types of immunotherapies can cause different side effects. The most common side effects of immunotherapy may include fatigue, rash, diarrhea, nausea, fever, muscle pain, bone pain, joint pain, abdominal pain, itching, vomiting, cough, decreased appetite, and shortness of breath. Immunotherapy can increase the risk of inflammation in different organs in your body.  Ask your doctor how you can address any side effects while you are on treatment. 

Immunotherapy Resources

What to Eat? Tips to Consider.

Managing Side Effects Webinar with Dr. Cathy Eng

What to Know About Immunotherapy for Colorectal Cancer 

Immunotherapy is Approved for MSI-H mCRC Patients 

Immunotherapy is currently FDA approved for metastatic colorectal cancer (mCRC) patients with microsatellite instability (MSI-H) who have progressed on other standard chemotherapy treatment. Biomarker testing can tell you if current immunotherapies are an option for you.

How to Find a Clinical Trial

Only a small subset of mCRC patients have MSI tumors. A majority have microsatellite stable (MSS) tumors, and current immunotherapy treatments have not shown benefit in MSS patients. There are clinical trials being conducted to learn more about immunotherapy in MSS patients. To find a clinical trial, visit the Fight CRC Clinical Trial Finder ,which has a filtered curation generated from all potential MSS-CRC patient-enrolling trials, and is based on parameters that are most important from the viewpoint of stage IV, MSS-CRC patients. The trials listed are sourced from a publicly available repository of all trials listed on, maintained by the Clinical Trials Transformation Initiative (CTTI). 

Fight CRC is Convening Research

Since 2015, Fight CRC has convened the Immunotherapy (IO) Work Group. The IO Work Group consists of multidisciplinary experts in the fields of CRC and IO from around the world, and it is committed to moving IO forward by synthesizing research, identifying gaps in translational and clinical research, and advising research. Fight CRC works with this group and engages them to discuss priorities for projects and funding.