| Title: |
Clinical Evidence on Particle Radiation, DNA Damage Response Inhibitors, and Immunotherapy for Mismatch Repair-Proficient Rectal Cancer |
| Authors: |
Cristian J. Salazar-Vilches; Daniel K. Ebner; Jake A. Kloeber; Sonja Dragojevic; Jasvinder Singh; Michael Haddock; Yasamin Sharifzadeh; Alexander D. Sherry; Krishan R. Jethwa; Christopher L. Hallemeier; Kenneth Merrell; Robert W. Mutter; Zhenkun Lou; Cameron M. Callaghan |
| Source: |
Cancers ; Volume 18 ; Issue 4 ; Pages: 652 |
| Publisher Information: |
Multidisciplinary Digital Publishing Institute |
| Publication Year: |
2026 |
| Collection: |
MDPI Open Access Publishing |
| Subject Terms: |
rectal cancer; particle therapy; immunotherapy; DNA damage response inhibitors |
| Description: |
Background/Objectives: We performed a systematic review of the current clinical and preclinical literature on the use of particle therapy, DDRi, and/or immunotherapy, specifically for pMMR colorectal cancer. Methods: A systematic review of the literature published between 2014 and 2025 was conducted across major databases. Studies were included if they examined particle radiotherapy (e.g., proton, alpha, carbon) either alone or in combination with DDRi and/or immune checkpoint inhibitors (ICI), or X-ray radiotherapy (XRT) in combination with DDRi/ICI. Results: In total, 133 studies met the inclusion criteria, including 62 clinical studies. Clinically, particle therapies show excellent local control and normal tissue sparing, with manageable toxicity profiles. Trials with any form of radiation and DDRi are few, potentially owing to toxicity concerns. ICI combinations showed promising efficacy with XRT, with no randomized trials comparing them to particle radiation. Conclusions: Particle radiation and/or DDRi have significant preclinical evidence of immunostimulatory effects in pMMR rectal adenocarcinoma and increase response rates to immunotherapy (presented in the companion manuscript). Despite strong preclinical evidence and rationale, clinical trials including all three modalities are scarce. Existing evidence suggests a potential benefit based on extrapolation from photon-based studies and supports prospective evaluation with careful attention to treatment-related toxicity, which remains a concern. |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
Methods and Technologies Development; https://dx.doi.org/10.3390/cancers18040652 |
| DOI: |
10.3390/cancers18040652 |
| Availability: |
https://doi.org/10.3390/cancers18040652 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.7FA65C01 |
| Database: |
BASE |