Is the combination of immunotherapy with conventional chemotherapy the key to increase the efficacy of colorectal cancer treatment?

Sep 24, 2026

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Colorectal cancer (CRC) is a prevalent, deadly malignancy worldwide, with projected growth in incidence from GLOBOCAN estimates. Current CRC management relies on surgery and conventional chemotherapy, notably 5-fluorouracil, whose limited efficacy and temporary benefits are constrained by adverse effects and frequent development of drug resistance. Immunotherapy has emerged as a hallmark strategy, especially for advanced stages, yet immune checkpoint inhibitors benefit only a subset of patients. This review synthesizes evidence on immune-modulating approaches, including immune molecules, cells, and transcription factors, highlighting the need to better define mechanisms linking CRC microenvironment changes to treatment responsiveness.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

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| W | J | G | O | World Journal of
Gastrointestinal Oncology | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Oncol 2023 February 15; 15(2): 251-267 DOI: 10.4251/wjgo.v15.i2.251 ISSN 1948-5204 (online) REVIEW 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 Specialty type: Oncology Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s scientific quality classification Grade A (Excellent): 0 Grade B (Very good): 0 Grade C (Good): C, C Grade D (Fair): 0 Grade E (Poor): 0 P-Reviewer: Tantau AI, Romania; Wismayer R, Uganda 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 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 Corresponding author: Luis I Terrazas, PhD, Chairman, Senior Scientist, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de Mé xico, Avenida de los Barrios \# 1, Tlalnepantla 54090, Estado de México, Mexico. [literrazas@unam.mx](literrazas@unam.mx) 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, abetter 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 WJGO [https://www.wjgnet.com](https://www.wjgnet.com) 251 February 15, 2023 Volume 15 Issue 2 Olguin JE et al. Immunotherapy on colorectal cancer 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

FAQs

Why does the review emphasize improving colorectal cancer treatment efficacy?

CRC is highly prevalent and lethal, and current therapies have limited effectiveness, temporary benefits, and problematic side effects. Drug resistance further drives progression, making better strategies necessary.

What role does immunotherapy play in colorectal cancer compared with conventional chemotherapy?

Conventional chemotherapy centered on 5-fluorouracil has low single-agent efficiency, but combinations can improve outcomes. Immunotherapy targets immune mechanisms, including immune molecules, cells, and transcription factors, aiming to enhance treatment effectiveness.

Why might immune checkpoint inhibitors not benefit all colorectal cancer patients?

Despite advances, the development and impact of immune checkpoint inhibitors in CRC remain under investigation, and fewer than 25% of patients show increased 5-year survival. This suggests heterogeneity in response and ongoing need for better predictive mechanisms.

Sep 24, 2026

Uploaded by moss~