Colorectal Cancer Immunotherapy

Immunotherapy is a type of colorectal cancer treatment that falls under targeted therapies. The goal of
immunotherapy is to boost a patient’s immune reaction to cancer cells, allowing them to fight disease.

Colorectal Cancer Immunotherapy

Immunotherapy is a type of colorectal cancer treatment that falls under targeted therapies. The goal of immunotherapy is to boost a patient’s immune reaction to cancer cells, allowing them to fight disease.

Immunotherapy has only been shown to be effective in a small subset of colorectal cancer patients. Immunotherapy is currently FDA approved for metastatic colorectal cancer (mCRC) patients with microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Biomarker testing can tell you if current immunotherapies are an option for you.

Immunotherapy has only been shown to be effective in a small subset of colorectal cancer patients. Immunotherapy is currently FDA approved for metastatic colorectal cancer (mCRC) patients with microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Biomarker testing can tell you if current immunotherapies are an option for you.

How does immunotherapy work?

Immunotherapy is also referred to as immuno-oncology. These are drugs in a category called “biologics,” which use substances made from living organisms. There are several different types of immunotherapy drugs:

  • Checkpoint inhibitors: Cancer cells are often surrounded by proteins that protect them from the body’s immune system. These drugs work to block those proteins, the “checkpoints,” allowing the immune cells to reach the cancer. There are several checkpoint inhibitors that have been approved by the FDA.

  • CAR-T cell therapy: Exciting work is being done with T cells. T cells are part of the immune system, a white blood cell, that work to fight off foreign substances in the body, like cancer cells. In this type of immunotherapy, your own T cells are harvested and then modified to better recognize cancer cells. The modified T cells are put back into your body. This type of research is in the early stages for colorectal cancer treatment and is available via clinical trials.

  • Cancer vaccines: Research is underway exploring cancer vaccines, which would be formulated to help train the immune system to identify and go after cancer cells. There are not currently any cancer vaccines approved for colorectal cancer, however there are clinical trials recruiting patients for cancer vaccines.

How does immunotherapy work?

Immunotherapy is also referred to as immuno-oncology. These are drugs in a category called “biologics,” which use substances made from living organisms. There are several different types of immunotherapy drugs:

  • Checkpoint inhibitors: Cancer cells are often surrounded by proteins that protect them from the body’s immune system. These drugs work to block those proteins, the “checkpoints,” allowing the immune cells to reach the cancer. There are several checkpoint inhibitors that have been approved by the FDA.

  • CAR-T cell therapy: Exciting work is being done with T cells. T cells are part of the immune system, a white blood cell, that work to fight off foreign substances in the body, like cancer cells. In this type of immunotherapy, your own T cells are harvested and then modified to better recognize cancer cells. The modified T cells are put back into your body. This type of research is in the early stages for colorectal cancer treatment and is available via clinical trials.

  • Cancer vaccines: Research is underway exploring cancer vaccines, which would be formulated to help train the immune system to identify and go after cancer cells. There are not currently any cancer vaccines approved for colorectal cancer, however there are clinical trials recruiting patients for cancer vaccines.

FDA Approved Immunotherapy Drugs for Colorectal Cancer

Is an option for the first-line treatment of patients with unresectable or metastatic MSI-H or dMMR colorectal cancer.

Is for use in MSI-H or dMMR metastatic colorectal cancer. Nivolumab has been approved for metastatic colorectal cancer patients whose cancer either progressed after being treated with a fluoropyrimidine, oxaliplatin, and irinotecan, or did not respond to those treatments.

May be used in combination with nivolumab as a treatment option for metastatic colorectal cancer with MSI-H or dMMR cancer following the progression on a fluoropyrimidine, oxaliplatin, and irinotecan.

Can be given alone via IV and can only be used for metastatic colorectal cancer that is MSI-H or dMMR. Dostarlimab is not currently approved specifically to treat metastatic colorectal cancer, but has been used off-label, and is a recommended option per National Comprehensive Cancer Network Guidelines®.

FDA Approved Immunotherapy Drugs for Colorectal Cancer

Is an option for the first-line treatment of patients with unresectable or metastatic MSI-H or dMMR colorectal cancer.

Is for use in MSI-H or dMMR metastatic colorectal cancer. Nivolumab has been approved for metastatic colorectal cancer patients whose cancer either progressed after being treated with a fluoropyrimidine, oxaliplatin, and irinotecan, or did not respond to those treatments.

May be used in combination with nivolumab as a treatment option for metastatic colorectal cancer with MSI-H or dMMR cancer following the progression on a fluoropyrimidine, oxaliplatin, and irinotecan.

Can be given alone via IV and can only be used for metastatic colorectal cancer that is MSI-H or dMMR. Dostarlimab is not currently approved specifically to treat metastatic colorectal cancer, but has been used off-label, and is a recommended option per National Comprehensive Cancer Network Guidelines®.

How do I find a
clinical trial?

Only a small subset (4-5%) of mCRC patients have MSI-H tumors. A majority of patients 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. Additionally, there are still immunotherapy clinical trials for MSI-H patients. For example, trials to discover earlier stage disease or new types of treatments, like vaccines.

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 ClinicalTrials.gov, maintained by the Clinical Trials Transformation Initiative (CTTI).

How do I find a clinical trial?

Only a small subset (4-5%) of mCRC patients have MSI-H tumors. A majority of patients 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. Additionally, there are still immunotherapy clinical trials for MSI-H patients. For example, trials to discover earlier stage disease or new types of treatments, like vaccines.

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 ClinicalTrials.gov, maintained by the Clinical Trials Transformation Initiative (CTTI).

Side Effects

Like all types of cancer treatment, immunotherapies come with 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
  • 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.

Side Effects

Like all types of cancer treatment, immunotherapies come with 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
  • 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.

Fight CRC’s Immunotherapy Work Group

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.

Fight CRC’s Immunotherapy Work Group

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.