Opdivo (nivolumab) + Yervoy (ipilimumab) in First-Line MSI-H Metastatic Colon Cancer. What Did the CheckMate-8HW Trial Show
The results of CheckMate-8HW in patients with MSI-H unresectable or metastatic colon cancer were recently published in one of the world's leading oncology journals. First-line Opdivo (nivolumab) + Yervoy (ipilimumab) was compared with chemotherapy. The combination showed a convincing benefit in progression-free survival and better tolerability in terms of severe adverse events.
In brief: what happened
The first-line analysis included 303 patients who had not previously received systemic therapy for metastatic disease.
- In 255 patients, MSI-H status was confirmed by central testing.
- The 24-month progression-free survival was 72% with dual immunotherapy versus 14% with chemotherapy.
- Grade 3–4 treatment-related adverse events occurred in 23% of patients on immunotherapy and in 48% on chemotherapy.
Key numbers from the trial
At a median follow-up of 31.5 months, progression-free survival was statistically significantly better with the combination of nivolumab and ipilimumab than with chemotherapy. For MSI-H colorectal cancer, this is one of the strongest randomized confirmations of the advantage of an immune-based approach in the first line.
Why this matters in practice
In MSI-H metastatic colon cancer, the question of choosing the first line has long moved beyond standard cytotoxic chemotherapy. CheckMate-8HW further reinforces the need for molecular profiling already at the start.
Limitations / what does not change yet
These data apply only to MSI-H tumors. They do not extend to colon tumors without microsatellite instability. Correct molecular diagnostics are of key importance.
When a second opinion is especially useful
- the molecular MSI status has not yet been determined;
- standard chemotherapy is being proposed without discussing immunotherapy;
- doctors' opinions differ regarding the first line;
- it is important to understand to what extent the aggressiveness of the disease allows waiting for the effect of immunotherapy.
What to prepare for the consultation
- histopathology report;
- results of testing for microsatellite instability;
- CT of the chest, abdomen and pelvis;
- discharge summary with the clinical diagnosis and stage;
- list of symptoms and comorbidities;
- list of all medications you are taking.
Frequently Asked Questions
Is this regimen suitable for all patients with metastatic colorectal cancer?
No. Only for patients with an MSI-H or dMMR tumor.
Is it mandatory to know the MSI/MMR status before choosing the first line?
Yes. After CheckMate-8HW this is a key parameter for discussing treatment.
Was the toxicity of dual immunotherapy worse than that of chemotherapy?
No. The rate of severe treatment-related adverse events was lower than with chemotherapy.
More answers on the FAQ page.