Neeoadjuvant pembrolizumab (keytruda) for colorectal cancer – pro
For early-stage colorectal cancer (CRC) with dMMR/MSI-H (mismatch repair deficient / microsatellite instability-high), neadjuvant pembrolizumab alone has shown very high pathological complete response (pCR) rates. In a recent development, pathologic complete response was the primary end point and was exceeded, supporting robust antitumor activity from short-course preoperative PD-1 blockade. The breakthrough data from the phase 2 NEOPRISM-CRC study (NCT05197322) may challenge the standard of care—chemotherapy following surgery—given that approximately 25% of patients have cancer recurrence within 3 years. The reports are exciting but early and preliminary, and not standard of care. NCCN still recommends only FOLFOX or CapeOx chemotherapy neoadjuvantly.
Colon cancer breakthrough keeps patients cancer-free for nearly 3 years. University College London. News release. May 6, 2026. Accessed May 14, 2026. https://www.sciencedaily.com/releases/2026/05/260505234618.htm
Shui KK, Jiang Y, Saunders M, et al. NEOPRISM-CRC: neoadjuvant pembrolizumab stratified to tumour mutation burden for high risk stage 2 or stage 3 deficient-MMR/MSI-high colorectal cancer. Presented at: 2024 ASCO Annual Meeting. May 31-June 3, 2026; Chicago, IL.
NCCN COlon Cancer COL-5, 2026