Immunotherapy drug Keytruda received FDA approval and showed benefit for treatment of colorectal cancer

Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides expert-developed guidelines for tumor testing for people with colorectal cancer. NCCN recommends the following for tumor testing in people with colorectal cancer:

• All newly-diagnosed colorectal cancers should be tested for microsatellite instability (MSI) or mismatch repair deficiency (dMMR or MMR-D).  
  • People diagnosed with advanced MSI-H/dMMR cancers may benefit from treatment with a type of immunotherapy known as immune checkpoint inhibitors.
• Depending on MMR/MSI test results, referral for genetic counseling for an inherited gene mutation associated with Lynch syndrome. 
• Additional tumor tests may help determine treatment options in metastatic colorectal cancer. This includes testing for:
  • BRAF V600E
  • KRAS
  • NRAS
  • HER2

Questions To Ask Your Health Care Provider

• What are the best drug options for treating my colorectal cancer?
• What are the side effects of my treatment drugs?
• Which biomarkers was my cancer tested for? What were the results?
• Is my cancer due to microsatellite instability or mismatch repair deficiency?
• Can you provide a copy of my biomarker test results?
• Do I meet criteria for genetic counseling and testing for an inherited mutation?
• Can you refer me to a genetic counselor?
• Should I consider a clinical trial?

Open Clinical Trials

The following are studies enrolling people with advanced colorectal cancer.  

• NCT03607890: Nivolumab and Relatlimab in Advanced MSI-H Cancers Resistant to Prior PD-(L)1 Inhibitor. The purpose of this study is to evaluate the safety, effectiveness, and tolerability of using the immunotherapy drugs nivolumab and relatlimab in patients with microsatellite instability high (MSI-H) solid tumors resistant to prior PD-(L)1 therapy.
• NCT02997228: Chemotherapy, Bevacizumab, and/or Atezolizumab for dMMR / MSI-H Metastatic Colorectal Cancer (COMMIT Study). The study will compare how well a combination of chemotherapy and immunotherapy works compared with an immunotherapy drug alone.
• NCT03337087: Treating Metastatic Pancreatic, Colorectal, Gastroesophageal, or Biliary Cancer with Chemotherapy and Rucaparib. This study will look at how the targeted therapy, rucaparib works with chemotherapy in treating patients with metastatic pancreatic, colorectal, gastroesophageal, or biliary cancer.
• NCT04008030: Nivolumab, Nivolumab Plus Ipilimumab, or Chemotherapy for Microsatellite Instability High (MSI-H) Metastatic Colorectal Cancer.The study will compare the combination of immunotherapy agents nivolumab (Opdivo) plus ipilimumab (Yervoy) in patients who have MSI-H or dMMR metastatic colorectal cancer versus using nivolumab alone or chemotherapy. 

A number of other clinical trials for patients with colorectal cancer can be found here.