Abstract
Metastatic colorectal cancer (mCRC) is a leading cause of cancer-related mortality with a 5-year overall survival rate of 13%. Despite recent advances in cancer immunotherapy, only the minority of CRC patients (<15%) with microsatellite instability can potentially benefit from immune checkpoint inhibitors, the only immunotherapy currently approved for mCRC. In that context, there is an unmet need to improve survival in mCRC. Our ever-increasing understanding of the immune system and its interactions with cancer has allowed development of multiple strategies to potentially improve outcomes in the majority of mCRC patients. Various approaches to manipulate patient immunity to recognize and kill colorectal cancer cells are being explored simultaneously, with combination therapies likely being the most effective. Ideally, therapies would target tumor-restricted antigens selectively found in tumors, but shielded from immune attack in normal tissues, to mount an effective cytotoxic T-cell response, while also overcoming cellular and molecular inhibitory pathways, self-tolerance, and T-cell exhaustion. Here, we provide a brief overview of the most promising immunotherapy candidates in mCRC and their strategies to produce a lasting immune response and clinical benefit in patients with mCRC.