Robust antitumor immunity in a patient with metastatic colorectal cancer treated with cytotoxic regimens.

Microsatellite stable (MSS) colorectal cancers (CRC) are characterized by low mutation burden and limited immune cell infiltration and thereby respond poorly to immunotherapy. Here, we report a case of metastatic MSS CRC with a robust anticancer immune response. The primary tumor was resected in 2012 and the patient received several cycles of chemotherapy until 2017. In 2018, the patient underwent a left hepatectomy to remove a new metastasis. Analysis of the metastatic tumor revealed a strong CD8+ T-cell response. A high frequency of CD8+ T cells co-expressed CD39 and CD103, a phenotype characteristic of tumor-reactive cells. Using whole-exome sequencing, we identified somatic mutations that generated peptides recognized by CD39+CD103+CD8+ T cells. The observed reactivity against the tumor was dominated by the response to a single mutation that emerged in the metastasis. Somatic mutations that were not immunogenic in the primary tumor led to robust CD8+ T-cell expansion later during disease progression. Our data suggest that the cytotoxic treatment regimen received by the patient might be responsible for this effect. Hence, the capacity of cytotoxic regimens to prime the immune system in CRC patients should be investigated further and might provide a rationale for combination with immunotherapy.