Nicholas Hornstein, Assistant Professor at Northwell Health, shared a post on LinkedIn:
“ATOMIC finally published, bringing immunotherapy into the non-metastatic MSI-H adjuvant CRC setting.
We’ve been treating these patients with FOLFOX because we had to. Not because anyone wanted to (Sargent et al showed 5-FU alone is downright harmful).
But at the same time, the rest of the field is moving fast… and not necessarily in the same direction.
Here’s what ATOMIC shows:
Population
- Resected stage III dMMR/MSI-H colon cancer
- More than half high-risk (T4 and/or N2)
Design
- FOLFOX + Atezo VS FOLFOX alone
Efficacy
- 3-year DFS ~86% vs ~76%
- HR ~0.50
- About a 10% absolute improvement
Toxicity
- Higher grade 3-4 events with the combination
- More immune-related tox (duh)
Overall survival maturing
On its face, this is practice-changing. IO plus chemotherapy is the new Textbook default for stage III MSI-H disease.
But things are moving very fast in the MSI-H space.
We now have two competing signals:
- ATOMIC: adding IO improves DFS after surgery
- Neoadjuvant MSI-H data: some patients may not need chemo, or even surgery
And one major elephant in the room:
Atezolizumab has consistently underperformed compared to PD-1 agents in MSI-H CRC.
Bottom line:
ATOMIC changes practice today. But most people are moving to neoadjuvant. And if they aren’t? Well, they probably should be looking very carefully at their PD1/PDL-1 choice in CRC…”
Title: Atezolizumab plus FOLFOX for Stage III Mismatch Repair-Deficient Colon Cancer
Authors: Frank A. Sinicrope, Fang-Shu Ou, Dirk Arnold, Walter R. Peters, Robert J. Behrens, Christopher H. Lieu, Khalid Matin, Deirdre J. Cohen, Samara L. Potter, Andrew B. Nixon, Lisa A. Kottschade, Emily Kathol, Wendy L. Frankel, Ardaman Shergill, Dennis Hsu, Anke Reinacher-Schick, Paul Mehan, Philip J. Gold, Maged F. Khalil, Tyler Zemla, Clare Gatten, Eileen M. O’Reilly, Jeffrey A. Meyerhardt
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