The “Immunoscore” in rectal cancer: could we search quality beyond quantity of life?

// Amos Kirilovsky 1 , 2 , 3 , 4 , * , Carine El Sissy 1 , 2 , 3 , 4 , * , Guy Zeitoun 4 , * , Florence Marliot 1 , 2 , 3 , 4 , Nacilla Haicheur 4 , Christine Lagorce-Pagès 1 , 2 , 3 , 5 , Julien Taieb 6 , Mehdi Karoui 7 , Petra Custers 8 , 9 , Edina Dizdarevic 10 , 11 , Soledad Iseas 12 , Torben Frøstrup Hansen 10 , 11 , Lars Henrik Jensen 10 , 11 , Geerard Beets 8 , 9 , Jean Pierre Gérard 13 , Mireia Castillo-Martin 14 , Nuno Figueiredo 15 , 16 , Angelita Habr-Gama 17 , Rodrigo Perez 17 , Jérôme Galon 1 , 2 , 3 and Franck Pagès 1 , 2 , 3 , 4 1 Laboratory of Integrative Cancer Immunology, INSERM, Paris, France 2 Equipe Labellisée Ligue Contre le Cancer, Paris, France 3 Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France 4 Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France 5 Department of Pathology, AP-HP, Georges Pompidou European Hospital, Paris, France 6 Department of Gastroenterology and Gastrointestinal Oncology, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France 7 Department of Digestive Surgery, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France 8 Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands 9 GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands 10 Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark 11 Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark 12 Oncology Unit, Gastroenterology Hospital, Dr. Carlos Bonorino Udaondo, Ciudad Autónoma de Buenos Aires, Argentina 13 Department of Radiation Oncology, Centre Antoine Lacassagne, Nice Sophia-Antipolis University, Nice, France 14 Service of Pathology, Champalimaud Foundation Biobank (CFB)/Champalimaud Centre for the Unknown/Champalimaud Foundation, Lisbon, Portugal 15 Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal 16 Colorectal Surgery, Lusiadas Hospital Lisboa, Lisbon, Portugal 17 Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, São Paulo, Brazil * These authors contributed equally to this work Correspondence to: Franck Pagès, email: franck.pages@aphp.fr Keywords: rectal cancer; immunoscore; watch and wait; prognosis; radiochemotherapy Received: September 15, 2021     Accepted: September 26, 2021     Published: January 05, 2022 Copyright: © 2022 Kirilovsky et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ABSTRACT Because of the function and anatomical environment of the rectum, therapeutic strategies for local advanced rectal cancer (LARC) must deal with two challenging stressors that are a high-risk of local and distal recurrences and a high-risk of poor quality of life (QoL). Over the last three decades, advances in screening tests, therapies, and combined-modality treatment options and strategies have improved the prognosis of patients with LARC. However, owing to the heterogeneous nature of LARC and genetic status, the patient may not respond to a specific therapy and may be at increased risk of side-effects without the life-prolonging benefit. Indeed, each therapy can cause its own side-effects, which may worsen by a combination of treatments resulting in long-term poor QoL. In LARC, QoL has become even more essential with the increasing incidence of rectal cancer in young individuals. Herein, we analyzed the value of the Immunoscore-Biopsy (performed on tumor biopsy at diagnosis) in predicting outcomes, alone or in association with clinical and imaging data, for each therapy used in LARC.