Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2023; 15(11): 1925-1935
Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.1925
Application of sintilimab combined with anlotinib hydrochloride in the clinical treatment of microsatellite stable colorectal cancer
Rui Feng, De-Xin Cheng, Xiao-Chen Chen, Liu Yang, Hao Wu
Rui Feng, De-Xin Cheng, Department of Interventional Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Xiao-Chen Chen, Liu Yang, Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Hao Wu, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Author contributions: Feng R and Wu H designed the study; Cheng DX, Chen XC, and Yang L performed the experiments; Feng R, Cheng DX, and Chen CX analyzed the data; Feng R wrote the manuscript; Wu H reviewed and revised the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of Zhejiang Provincial People’s Hospital.
Informed consent statement: The data used in this study were not involved in the patients’ privacy information, so the informed consent was waived by the Ethics Committee of Zhejiang Provincial People’s Hospital. All data obtained, recorded, and managed was only used for this study, without any harm to the patients.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Wu, MM, Attending Doctor, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou 310000, Zhejiang Province, China. wuhao89899@163.com
Received: September 7, 2023
Peer-review started: September 7, 2023
First decision: September 15, 2023
Revised: September 23, 2023
Accepted: September 27, 2023
Article in press: September 27, 2023
Published online: November 15, 2023
Processing time: 69 Days and 10.8 Hours
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer (CRC) is one of the most common types of cancer worldwide, accounting for a significant number of cancer-related deaths. Microsatellite stable (MSS) CRC is a subtype of CRC characterized by a stable genomic pattern. Traditional chemotherapy regimens have shown limited efficacy in treating MSS CRC, highlighting the need for novel therapeutic approaches. Immunotherapy, particularly immune checkpoint inhibitors, has emerged as a promising treatment strategy for various cancers, including MSS CRC.

Research motivation

Despite the substantial success of immune checkpoint inhibitors in the treatment of microsatellite instability-high CRC, their efficacy in MSS CRC remains uncertain. Additionally, the exploitation of combination therapies has emerged as a potential strategy to enhance treatment outcomes. Thus, exploring the combination of sintilimab (an anti-PD-1 monoclonal antibody) and anlotinib hydrochloride (a tyrosine kinase inhibitor) in the clinical treatment of MSS CRC could provide new insights and potential benefits.

Research objectives

The primary objective of this study was to evaluate the clinical efficacy and safety of sintilimab combined with anlotinib hydrochloride in the treatment of MSS CRC. Specifically, the study aimed to assess the safety profile, serum markers, and quality of life in MSS CRC patients receiving this combination therapy.

Research methods

In a study conducted from 2019 to 2022, 92 patients diagnosed with CRC were divided into an observation group and a control group. The observation group received additional treatment with sintilimab on top of the treatment given to the control group, which received anlotinib hydrochloride. Treatment was administered in cycles of 3 wk, and after two consecutive cycles, the efficacy was evaluated.

Research results

The observation group showed significantly better short-term efficacy compared to the control group (76.09% vs 50.00%, P < 0.05). The observation group also exhibited significant decreases in serum markers after treatment, which were lower than both the pretreatment levels and the post-treatment levels in the control group (P < 0.05). The T cell subset levels in the observation group significantly improved after treatment and surpassed both the pretreatment levels and the post-treatment levels in the control group (P < 0.05). Additionally, the observation group demonstrated significant improvements in various dimensions of quality of life, surpassing both the pretreatment levels and the post-treatment levels in the control group (P < 0.05). During the 1-year follow-up period, 1 patient in the observation group and 2 patients in the control group were lost to follow-up. In the observation group, 12 patients died, resulting in a survival rate of 73.33% (33/45), while in the control group, 21 patients died, resulting in a survival rate of 52.27% (23/44). Kaplan-Meier survival analysis showed a significant difference in survival rates between the two groups (log-rank = 4.710, P = 0.030).

Research conclusions

The combination of sintilimab and anlotinib hydrochloride demonstrated significant efficacy in the treatment of CRC patients, improving immunity and prognosis.

Research perspectives

While this study provided valuable insights into the efficacy and safety of sintilimab combined with anlotinib hydrochloride in MSS CRC, further research is warranted. Future studies could focus on exploring the underlying mechanisms of the observed therapeutic effects, defining predictive biomarkers for treatment response, and optimizing the treatment regimen. Additionally, investigating the potential synergy between immunotherapy and other targeted therapies may enhance treatment outcomes in MSS CRC and advance precision medicine approaches.