Olguin JE, Mendoza-Rodriguez MG, Sanchez-Barrera CA, Terrazas LI. Is the combination of immunotherapy with conventional chemotherapy the key to increase the efficacy of colorectal cancer treatment? World J Gastrointest Oncol 2023; 15(2): 251-267 [PMID: 36908325 DOI: 10.4251/wjgo.v15.i2.251]
Corresponding Author of This Article
Luis I Terrazas, PhD, Chairman, Senior Scientist, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Avenida de los Barrios # 1, Tlalnepantla 54090, Estado de México, Mexico. literrazas@unam.mx
Research Domain of This Article
Immunology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Feb 15, 2023; 15(2): 251-267 Published online Feb 15, 2023. doi: 10.4251/wjgo.v15.i2.251
Is the combination of immunotherapy with conventional chemotherapy the key to increase the efficacy of colorectal cancer treatment?
Jonadab E Olguin, Monica G Mendoza-Rodriguez, C Angel Sanchez-Barrera, Luis I Terrazas
Jonadab E Olguin, Luis I Terrazas, Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Estado de Mexico, Mexico
Monica G Mendoza-Rodriguez, C Angel Sanchez-Barrera, Luis I Terrazas, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Estado de Mexico, Mexico
Author contributions: Olguin JE and Mendoza-Rodriguez MG contributed equally to this work; Olguin JE, Mendoza-Rodriguez MG, and Terrazas LI contributed to conception and design; Olguin JE and Terrazas LI contributed to the search for information related to the immune response; Mendoza-Rodriguez MG and Sanchez-Barrera CA contributed to the search for information related to chemotherapy; Olguin JE and Mendoza-Rodriguez MG contributed to figure development; Olguin JE, Mendoza-Rodriguez MG, Sanchez-Barrera CA, and Terrazas LI contributed to paper writing; Olguin JE, Mendoza-Rodriguez MG, and Terrazas LI contributed to funding resources.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Luis I Terrazas, PhD, Chairman, Senior Scientist, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Avenida de los Barrios # 1, Tlalnepantla 54090, Estado de México, Mexico. literrazas@unam.mx
Received: September 24, 2022 Peer-review started: September 24, 2022 First decision: October 20, 2022 Revised: November 3, 2022 Accepted: January 10, 2023 Article in press: January 10, 2023 Published online: February 15, 2023
Abstract
Colorectal cancer (CRC) is among the most prevalent and deadly neoplasms worldwide. According to GLOBOCAN predictions, its incidence will increase from 1.15 million CRC cases in 2020 to 1.92 million cases in 2040. Therefore, a better understanding of the mechanisms involved in CRC development is necessary to improve strategies focused on reducing the incidence, prevalence, and mortality of this oncological pathology. Surgery, chemotherapy, and radiotherapy are the main strategies for treating CRC. The conventional chemotherapeutic agent utilized throughout the last four decades is 5-fluorouracil, notwithstanding its low efficiency as a single therapy. In contrast, combining 5-fluorouracil therapy with leucovorin and oxaliplatin or irinotecan increases its efficiency. However, these treatments have limited and temporary solutions and aggressive side effects. Additionally, most patients treated with these regimens develop drug resistance, which leads to disease progression. The immune response is considered a hallmark of cancer; thus, the use of new strategies and methodologies involving immune molecules, cells, and transcription factors has been suggested for CRC patients diagnosed in stages III and IV. Despite the critical advances in immunotherapy, the development and impact of immune checkpoint inhibitors on CRC is still under investigation because less than 25% of CRC patients display an increased 5-year survival. The causes of CRC are diverse and include modifiable environmental factors (smoking, diet, obesity, and alcoholism), individual genetic mutations, and inflammation-associated bowel diseases. Due to these diverse causes, the solutions likely cannot be generalized. Interestingly, new strategies, such as single-cell multiomics, proteomics, genomics, flow cytometry, and massive sequencing for tumor microenvironment analysis, are beginning to clarify the way forward. Thus, the individual mechanisms involved in developing the CRC microenvironment, their causes, and their consequences need to be understood from a genetic and immunological perspective. This review highlighted the importance of altering the immune response in CRC. It focused on drugs that may modulate the immune response and show specific efficacy and contrasted with evidence that immunosuppression or the promotion of the immune response is the answer to generating effective treatments with combined chemotherapeutic drugs.
Core Tip: This review focused on the drugs that may modulate the immune response and show specific efficacy in the treatment of colorectal cancer. We then presented the evidence that immunosuppression or promotion of the immune response is the answer to generating effective treatments with combined chemotherapeutic drugs.
