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ASCO 2025 | Practice-changing CRC cancer trials at ASCO 2025: ATOMIC & CheckMate 8HW
J. Randolph Hecht, MD, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, gives an overview of much-awaited colorectal cancer (CRC) abstracts at the 2025 American Society of Clinical Oncology (ASCO) Meeting. The Phase III ATOMIC trial (NCT02912559) of adjuvant mFOLFOX6 alone or with atezolizumab for patients with stage III deficient DNA mismatch repair (dMMR) colon cancer demonstrated improved relapse-free survival in patients receiving atezolizumab. Expanded analyses from the CheckMate 8HW trial (NCT04008030) of nivolumab alone or with ipilimumab microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) mCRC showed that addition of ipilimumab continues to be superior to standard treatment. This interview took place during the 2025 ASCO Meeting in Chicago, IL.
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Transcript
The highlights so far, I’m a GI oncologist, so I can’t speak to anything else. The potentially practice-changing studies that were presented, but both of them, we will change our practice, but we still have questions. The first one was ATOMIC, which was in MSI-high colon cancer. So it’s about 3% of metastatic disease, but actually up to 10% of patients with stage three and earlier stages...
The highlights so far, I’m a GI oncologist, so I can’t speak to anything else. The potentially practice-changing studies that were presented, but both of them, we will change our practice, but we still have questions. The first one was ATOMIC, which was in MSI-high colon cancer. So it’s about 3% of metastatic disease, but actually up to 10% of patients with stage three and earlier stages. And we know that on one hand those patients do better, we also know that they’re actually more resistant to adjuvant chemotherapy and chemotherapy in general. So the ATOMIC trial was a large cooperative group funded showing how important the NCI and funding of research is from the federal government. And that was chemotherapy plus or minus a PD-L1, atezolizumab. And what they showed was about a 10% improvement that was across the curve. So about a 10% improvement in relapse-free survival. And I think that will be the standard of care. It was generally well-tolerated. We all, as oncologists, we all know about immune-related adverse events, but it seemed to be very well-tolerated. The question for the future and the problem is these trials take huge numbers of patients and a long period of time to do. So may not have designed the trial exactly the same way, but we’re sort of stuck with what was designed 10 years ago or so. So one is that we know from the recently updated, including here at ASCO, the CheckMate 8HW trial that was presented at ASCO GI by Thierry André and updated by Heinz-Josef Lenz here that patients actually who were current at metastatic disease can do really well for a long period of time and we’re even almost thinking about the cure word for them so you can salvage patients and that was with nivolumab and ipilimumab. The second is that there’s data as Dr Chalabi, who is a discussant, presented that preoperative immunotherapy is incredibly effective and you only need a couple doses and most of those patients have pathologic complete response. So, that is practice changing, but I think there’s going to be a lot more studies to follow that may be able to optimize this.
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