ESSO 45 | Multidisciplinary approaches to neoadjuvant immunotherapy in dMMR colon cancer

So this is a tough question, actually. And we discussed yesterday in our session together with the fellow oncologists and surgeons, because this is the matter of debdate. We saw incredible benefit of immunotherapy, in the neoadjuant setting in several studies with a very high percentage of pathological pre-response and also DFS. We know from NICH2, but many other trials. We now facing the challenge that we don’t know exactly which is the best treatment strategies, whether it’s a doublet for a short period or a monotherapy for a long period. Probably the best way is going to be the first. But we don’t have strong data. To define which is the best, because actually we see very important results with all these strategies. I think from a clinical point of view, we have to have a strong multidisciplinary team, where oncologists, radiologists, surgeons have the DMMR status before resection, and they can discuss together whether the patient has a high risk, so not positive. And in that case, I believe that the neoadjuvant will work. It will give the most benefit. Whether we decide to go to resection first, because we believe it’s a low risk patient, but we see at the pathology afterwards a high risk stage 3, we can actually implement the ATOMIC strategy with FOLFOX Plus atezolizumab, which is now FDA approved, is not still European and approved. So, it’s not. It’s not still globally approved, but it can be a strategy.