Colorectal cancer immunotherapy: a treatment quantum leap

Surgery is the cornerstone in the treatment of non-metastatic colorectal cancer, supported by selective use of systemic chemotherapy and radiotherapy to improve distant and local control respectively. Radiotherapy has already been shown to be more effective in the neoadjuvant setting, with greater compliance than in the adjuvant setting. Recent studies have suggested this also true for systemic chemotherapy. In rectal cancer, neoadjuvant radiotherapy has led to the concept of organ preservation for tumours that respond very well. Additional neoadjuvant systemic therapy will increase the proportion of patients who do not require major surgery1,2. Recent progress in immunotherapy will decrease the role of major resections in the treatment of colorectal cancer even further. The idea of harnessing a patients’ own immune system to battle cancer cells is old, with William Coley as an often-mentioned surgical pioneer who provided proof of concept as early as 1891, with injections...