Trials like the dostarlimab study in rectal cancer and NICHE in colon cancer show neoadjuvant immunotherapy can induce profound responses in MSI-high tumors. This is creating a new paradigm where major surgery might be avoided entirely for some patients, marking a significant shift in treatment strategy.

The success of neoadjuvant immunotherapy trials like Niagara and those with EV-Pembro means most patients will receive immune therapy before surgery. This fundamentally shifts the clinical landscape, making the question of starting adjuvant immunotherapy less relevant as perioperative treatment becomes the standard.

The rapid adoption of neoadjuvant immunotherapy as the superior standard of care means this new adjuvant vaccine faces an uphill battle for relevance. Its true future impact hinges on proving its efficacy when combined with neoadjuvant therapy, a combination that could potentially lead to unprecedentedly low relapse rates for patients.

Injecting a genetic medicine into one tumor can trigger an 'abscopal response,' where the immune system learns to recognize the cancer. This educated immune system then travels throughout the body to find and destroy other metastatic tumors, even those in deep organs like the lungs, which are typically the fatal ones.

While immunotherapy is largely ineffective in metastatic microsatellite stable (MSS) colorectal cancer, emerging data suggests it may have surprising efficacy in the early-stage (neoadjuvant) setting. This differential response is likely due to a more favorable tumor microenvironment in earlier disease, suggesting a new therapeutic window.

Standard cancer surgery often removes lymph nodes—the factories producing immune cells. Administering immunotherapy *before* this destructive process is critical. It arms the immune system while it is still intact and capable of mounting a powerful, targeted response against the tumor.

Unlike chemotherapy, neoadjuvant immunotherapy appears more effective than adjuvant therapy because it leverages the in-situ tumor and its associated lymph nodes as a 'training ground.' This allows the immune system to generate a robust, specific anti-tumor response before the primary tumor and nodal basin are surgically removed.

Clinical trial data suggests immunotherapy's timing is crucial in early-stage TNBC. Given with chemotherapy before surgery (neoadjuvant), it improves outcomes. However, when given alone after surgery (adjuvant), the IMPASSION 030 trial showed no benefit and was halted for futility, indicating pre-surgical tumor priming is essential.

Unconventionally, Infinitopes' first-in-human trial targets neoadjuvant patients (newly diagnosed, pre-surgery). This provides cleaner efficacy signals compared to trials in heavily pre-treated patients and enables unique analysis of resected tumors to prove the vaccine's mechanism, a key differentiator from competitors.