Improving CRC patient triage in the COVID-19 era with Immunoscore®

Immunoscore® and COVID-19 Colorectal Cancer Guidelines

Improving CRC patient triage in the COVID-19 era with Immunoscore®

 

In response to COVID-19 pandemic, the major international cancer societies and national health authorities issued a flurry of guidelines for the management of cancer patients recommending reducing exposure of cancer patients to the SARS-Cov-2 virus by reprioritising prevention in treatment strategies.

Triage of CRC patients has, therefore, become essential.

But how can triage decisions be documented being performed without altering the clinical outcomes?

Immunoscore test abilities correspond to a large extent of the unmet needs of this pandemic period. Sustaining this common trend resulted from our in-depth analysis, the Ruesch center in Georgtown, a reference centre for gastro-intestinal cancer recommendations could be particularly highlighted. To achieve implementing COVID triage, this independent publication advocates pragmatical solutions for the COVID-19 era, precision medicine with immune response biomarkers for optimising treatment.[1]    

If Prognosis for patients with resectable colon cancer has traditionally depended on histological sample examination, the advent of individualised precision medicine and particularly, digitised analysis of biomarkers offers a new paradigm in the management of CRC.[2] Indeed, the World Health Organization (WHO) in the latest edition of Digestive System Tumours (5th edition) has introduced immune response as an essential and desirable diagnostic criteria for colorectal cancer in addition to traditional histological parameters.[3]

IMMUNOSCORE®

Immunoscore® is an in vitro diagnostic assay to assess the risk of relapse in colon cancer patients, and, used in conjunction with TNM staging, it helps to guide treatment strategies.[4] Immunoscore® assesses immune response at the site of the tumour using a digital pathology-based methodology involving measurement of CD3+ and CD8+ T-lymphocytes in defined regions of the tumour. An “immunoscore” is then generated, which is strongly correlated with the patient’s risk of recurrence.[4]

Immunoscore® – Improving risk assessment for better patient management.[4]

VALIDATED FOR PROGNOSIS IN STAGE II AND III COLON CANCER

The ability of Immunoscore® to identify which patients are most likely to experience a recurrence has been shown to be reproducible, reliable and robust.[5] In the large SITC-led study involving more than 3,000 stage I-III colon cancer patients, Immunoscore® was strongly predictive of patient outcomes, and to a greater degree than established indicators such as TNM classification or microsatellite instability (MSI).[5]  These findings have been confirmed in two prospective-retrospective studies of over 1,500 stage III colon cancer patients.[6,7]

Immunoscore® – Independent and stronger ability to predict survival than MSI. [5,7]

VALIDATED FOR TREATMENT ADJUSTMENT

In addition to more accurate prognostication, Immunoscore® has been demonstrated to be a predictive factor for facilitating treatment adjustment. In high-risk stage II colon cancer patients, Immunoscore® identified patients for whom adjuvant treatment could be avoided.[8] This was shown in a sub-group analysis of the SITC study data of stage II patients (n = 1,130).[20]

Immunoscore® has also been demonstrated to be a predictive factor for identifying stage III patients who benefit from longer FOLFOX treatment. In an analysis of the prospective IDEA French cohort data (n = 1,322), comparing 3 versus 6 months of oxaliplatin-based adjuvant chemotherapy in stage III colon cancer patients, Immunoscore® identified those patients who benefitted from a longer duration of treatment.[6]

Facilitating a 70% reduction in adjuvant chemotherapy in high-risk stage II patients and around a 50% reduction from 6 to 3 months of FOLFOX therapy in patients with stage III colon cancer. [6,8]

Immunoscore

Immunoscore® – Identifying patients eligible for chemotherapy de-escalation.[6]

Individualised precision medicine in early-stage colon cancer facilitates putting the patient at the centre of their treatment,[2] with a digital process enabling rapid and contactless triage to optimise treatment schedules and avoid overtreatment, minimising risk and maximising outcomes.[6,4,5]

Implementation of more precise diagnostic tools will ensure better patient outcomes, heralding the widespread use of these tools and the beginning of a new era in precision medicine post-COVID-19.

Written by HalioDX. Information correct at time of publication.

 


[1] Marschall JL, Yarden RI, Weinberg BA. Colorectal cancer care in the age of coronavirus: strategies to reduce risk and maintain benefit. Colorect Cancer 2020;9.

[2]La Thangue NB, Kerr DJ. Predictive biomarkers: a paradigm shift towards personalized cancer medicine. Nat Rev Clin Oncol 2011;8:587-96.

[3] Digestive System Tumours. 5th ed. Geneva: World Health Organization; 2019.

[4] Blair HA. Immunoscore®: a diagnostic assay for clinical management of colon cancer. Mol Diagn Ther 2020.

[5] Pagès F, Mlecnik B, Marliot F, et al. International validation of the consensus Immunoscore for the classification of colon cancer: a prognostic and accuracy study. Lancet 2018;391:2128-39.

[6] Pagès F, André T, Taieb J, et al. Prognostic and predictive value of the Immunoscore in stage III colon cancer patients treated with oxaliplatin in the prospective IDEA France PRODIGE-GERCOR cohort study. Ann Oncol 2020.

[7] Sinicrope FA, Shi Q, Hermitte F, et al. Contribution of immunoscore and molecular features to survival prediction in stage lll colon cancer. JNCI Cancer Spectrum 2020.

[8] Galon J, Hermitte F, Mlecnik B, et al. Immunoscore clinical utility to identify good prognostic colon cancer stage II patients with high-risk clinico-pathological features for whom adjuvant treatment may be avoided. J Clin Oncol 2019;37:487.