Pashtoon Kasi, Medical Director of GI Medical Oncology at City of Hope Orange County, shared by Nicholas Hornstein, Assistant Professor of Medicine at Northwell Health, on LinkedIn:
“Great take from Nicholas Hornstein on my investigator-initiated trial that, with my protocol writer, we decided to call NEST1 four years ago.
Back then, we barely got a budget approved for a 12-patient pilot – the rest coming from my salary/discretionary funds – firmly hoping and believing there would be a NEST2.
Now NEST3 is OPEN: N=100 across the City of Hope National Clinical Trial Network!
- Brewing time matters
- Doubling time from 4-8 weeks doubled pathologic responses.
In NEST3, we’re looking at 12 weeks.
And now, the UNICORN dataset provides independent corroboration supporting ongoing NEST3 – and the future randomized ROBBIN trial.”
Quoting Nicholas Hornstein:
“NEST is a big deal, and now fully published.
24 patients with localized CRC. BOT + BAL (CTLA4 + PD1) before surgery. 60% with major responses.
We’ve been inching toward neoadjuvant therapy in colon cancer for years.
FOxTROT tried it with chemotherapy and showed there was something there.
NICHE then showed us that neoadjuvant immunotherapy can be wildly effective in dMMR/MSI-H colon cancer (I’m still pushing to rename this to Chalabi’s disease).
The real question has always been: can we make this work in pMMR/MSS disease?
NEST says yes.
Among the 22 pMMR tumors:
- 41% major pathologic response
- 32% pCR
- 59% had ≥50% tumor regression
- And no treatment-related delays to surgery.
Chalabi’s tumors (dMMR)? 100% MPR.
It’s only a phase II, but a 32% pCR rate in pMMR colon cancer with immunotherapy is kind of insane.
NEST is telling us MSS is be coming through the IO door next.
And now we have ROBBIN (the phase III) coming.
Get ready. Neoadjuvant therapy is going to become a much bigger part of how we treat colon cancer.
This is where CRC is going. ”
Title: Neoadjuvant Botensilimab/Balstilimab for localized mismatch repair proficient and deficient colon cancer: Results of the NEST phase 2 clinical trial
Authors:Manish A. Shah, Erika Hissong, Mehraneh D. Jafari, Pashtoon Murtaza Kasi, Maider Astorkia, Sahrish Khan, Casey Owens, Zhengming Chen, Heather Yeo, Fabio Socciarelli, Sandipto Sarkar, Alana Nguyen, Despina Siolas, Allyson Ocean, Kelly Garrett, Lea Lowenfeld, Alessio Pigazzi, Preethi Guniganti, Sanjay Patel, Doron Betel, Manuel Hidalgo
You don’t want to mis this: New Phase 2 NEST Results Support Neoadjuvant BOT+BAL in Colon Cancer – Agenus
