Oncotarget: The “Immunoscore” in rectal cancer

Oncotarget published "The “Immunoscore” in rectal cancer: could we search quality beyond quantity of life?" which reported that Over the last three decades, advances in screening tests, therapies, and combined-modality treatment options and strategies have improved the prognosis of patients with LARC.

However, owing to the heterogeneous nature of LARC and genetic status, the patient may not respond to a specific therapy and may be at increased risk of side-effects without the life-prolonging benefit.

Indeed, each therapy can cause its own side-effects, which may worsen by a combination of treatments resulting in long-term poor QoL.

In LARC, QoL has become even more essential with the increasing incidence of rectal cancer in young individuals.

Herein, we analyzed the value of the Immunoscore-Biopsy in predicting outcomes, alone or in association with clinical and imaging data, for each therapy used in LARC.

Dr. Franck Pagès said, "About a third of colorectal cancer cases are located in the rectum, making rectal cancer the eight most common cancer worldwide and a major health issue."

About a third of colorectal cancer cases are located in the rectum, making rectal cancer the eight most common cancer worldwide and a major health issue

The management of rectal cancer varies from that of colon cancer because of the increased risk of pelvic recurrence and a poorer overall survival.

Since the first description of radical surgical procedure, the history of rectal cancer treatments has been driven by the necessity to improve both oncological outcomes and quality of life, especially in patients with mid/low locally advanced rectal cancer.

During the last 30 years, breakthrough innovations as well as continuous evolution of technologies, techniques, and strategies have led to a shift from a surgical-dominated management to a multidisciplinary management of rectal cancer.

Figure 1: (A) Left: Representative image of rectal biopsies with tumor region (pink) and normal tissue (blue) or dysplasia excluded from the analysis (blue). Right: CD3+ and CD8+ T cells automatic detection. Bottom: Chart illustrating the IS_B calculation method: Densities of CD3+ and CD8+ T cells in the tumor are converted into percentile. The mean percentile of the densities are then calculated to generate IS_B percentile value, where IS_B low, intermediate and high subgroups are reflected by 0–25%, >25–70% and >70–100% percentile respectively. (B) The frequency of patients in each IS_B groups, according to the Dworak classification in locally advanced rectal cancer patients. (C) Prediction of pathologic response (ypTNM 0–1) based on IS_B mean score and the ycTNM classification ycTNM 0–I. (D) Percentage of recurrence-free in Watch and Wait patients after 5 years of treatment.

The management of rectal cancer with organ-preserving strategies allows avoiding radical surgery, postoperative complications, and short-term poor QoL particularly due to stoma formation.

As these multimodality treatment strategies become more common, but also more complex, clinicians and patients need the most accurate information before deciding which disease management pathway to follow because of the trade-off between QoL and LoL.

The Pagès Research Team concluded in their Oncotarget Research Output, "The IS, initially developed to predict the survival benefit of radical surgery in tumor samples, has recently proven to have predictive value for adjuvant chemotherapy response. However, many tumors including rectal cancers are now being treated by combined therapies where surgery may even be avoided, challenging the initial Immunoscore. We have thus developed an adapted-Immunoscore –ISB– that evaluates the natural immune reaction against a tumor on the only tumor material available before any therapy: tumor biopsies. This new biomarker should open new perspectives in personalized therapy especially given consistent data suggesting its capacity to predict the benefit of radiotherapy and chemotherapy, although prospective trials are needed to confirm this observation."

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DOI - https://doi.org/10.18632/oncotarget.28100

Correspondence to - Franck Pagès - franck.pages@aphp.fr

Keywords - rectal cancer, immunoscore, watch and wait, prognosis, radiochemotherapy

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