Survival of patients with deficient mismatch repair metastatic colorectal cancer in the pre-immunotherapy era

G. Emerens Wensink, Marloes A. G. Elferink, Anne M. May, Linda Mol, Patricia A. H. Hamers, Sandra D. Bakker, Geert-Jan Creemers, Jan Willem B. de Groot, Gerty J. de Klerk, Brigitte C. M. Haberkorn, Annebeth W. Haringhuizen, Ronald Hoekstra, J. Cornelis B. Hunting, Emile D. Kerver, Danielle Mathijssen-van Stein, Marco B. Polée, Johannes F. M. Pruijt, Patricia Quarles van Ufford-Mannesse, Sandra Radema, Ronald C. RietbroekLieke H. J. Simkens, Bea C. Tanis, Daan ten Bokkel Huinink, Manuel L. R. Tjin-A-Ton, Cathrien S. Tromp-van Driel, Monique M. Troost, Agnes J. van de Wouw, Franchette W. P. J. van den Berkmortel, Anke J. M. van der Pas, Ankie M. T. van der Velden, Marjan A. van Dijk, Joyce M. van Dodewaard-de Jong, Edith B. van Druten, Theo van Voorthuizen, Gerrit Jan Veldhuis, Henk M. W. Verheul, Hanneke J. H. M. J. Vestjens, Jeroen Vincent, Onno W. Kranenburg, Cornelis J. A. Punt, Geraldine R. Vink, Jeanine M. L. Roodhart, Miriam Koopman

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19 Citations (Scopus)


Background: Metastatic colorectal cancer patients with deficient mismatch repair (dMMR mCRC) benefit from immunotherapy. Interpretation of the single-arm immunotherapy trials is complicated by insignificant survival data during systemic non-immunotherapy. We present survival data on a large, comprehensive cohort of dMMR mCRC patients, treated with or without systemic non-immunotherapy. Methods: Two hundred and eighty-one dMMR mCRC patients (n = 54 from three prospective Phase 3 CAIRO trials; n = 227 from the Netherlands Cancer Registry). Overall survival was analysed from diagnosis of mCRC (OS), from initiation of first-line (OS1) and second-line (OS2) systemic treatment. Cox regression analysis examined prognostic factors. As comparison for OS 2746 MMR proficient mCRC patients were identified. Results: Of 281 dMMR patients, 62% received first-line and 26% second-line treatment. Median OS was 16.0 months (13.8–19.6) with antitumour therapy and 2.5 months (1.8–3.5) in untreated patients. OS1 was 12.8 months (10.7–15.2) and OS2 6.2 months (5.4–8.9) in treated dMMR patients. Treated dMMR patients had a 7.6-month shorter median OS than pMMR patients. Conclusion: Available data from immunotherapy trials lack a control arm with standard systemic treatment. Given the poor outcome compared to the immunotherapy results, our data strongly suggest a survival benefit of immunotherapy in dMMR mCRC patients.
Original languageEnglish
Pages (from-to)399-406
Number of pages8
JournalBritish journal of cancer
Issue number2
Early online date2020
Publication statusPublished - 19 Jan 2021

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