Phase 2 trial of neoadjuvant camrelizumab plus apatinib for locally advanced MSI-H/dMMR colorectal cancer

The phase 2 NEOCAP study, at two centers in Guangzhou (China) evaluated the combination of the PD-1 blocker camrelizumab and the angiogenesis inhibitor apatinib for previously untreated locally advanced microsatellite instability-high or mismatch repair-deficient colorectal cancer (MSI-H/dMMR CRC), with the possibility of organ preservation in patients with clinical complete response. Clinical complete response was seen in 54% of patients, and 46% were managed with watch-and-wait, including patients with colon cancer and multiple primary colorectal cancer. Among patients who underwent surgery for the primary tumor, 61% had a pathologic complete response. Grade 3-5 adverse events occurred in 38%. The authors conclude that neoadjuvant camrelizumab and apatinib showed promising antitumor activity in patients with locally advanced MSI-H/dMMR CRC. Longer follow-up is needed to assess the oncological outcomes of the watch-and-wait approach.