This article was initiated and funded by Bristol Myers Squibb, and developed in partnership with Professor Naureen Starling, Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust specialising in the treatment of gastrointestinal cancers, and Professor of Gastrointestinal Cancer Medicine at The Institute of Cancer Research.

Prescribing and adverse event reporting information can be found at the end of this article.

Every year, almost 44,000 people in the UK are diagnosed with colorectal cancer (CRC).¹ Although more than nine out of ten new cases (94%) are diagnosed in people over the age of 50, more than 2,600 new cases are diagnosed in people under the age of 50 each year.^{1, 2}

The rising incidence of early-onset CRC is a global phenomenon.² Although there is an increase in CRC due to the aging population, we are also seeing a second increase in early-onset CRC in patients under 50, for reasons yet to be explained.^2,3 Whilst more research needs to be done, factors such as diet, environmental exposures and a sedentary lifestyle, may be involved.³

With the growing rates of CRC, one of the main challenges I foresee in treating this disease – particularly in more advanced stages – is to identify all the different subgroups of patients whose cancers may behave in different ways and therefore may need different treatment approaches. However, advancements in diagnosis and innovative approaches to treatment are changing this for the better.

Biomarker testing is paving the way for scientific progress

Biomarker testing is crucial for diagnosing and treating CRC – it is used to identify mutations in genes such as rat sarcoma virus (RAS), B-Raf proto-oncogene (BRAF), and mismatch repair (MMR), and help decide which treatment is more likely to work for each patient.⁴ In metastatic CRC for example, mismatch repair deficiency (dMMR) occurs when the genes that repair mismatch errors in DNA replication are mutated or silenced, leading to microsatellite instability-high (MSI-H)/dMMR tumours.^5,6

I believe that routine biomarker testing, coupled with innovative therapies, has driven precision oncology treatment for patients whose tumours harbour these types of genetic aberrations.

In 2025, one of the most significant developments has been in the MSI-H or dMMR group of patients, which constitutes about 4% of patients with advanced CRC.⁷ Back in 2015, we saw the first data showing that patients with any dMMR cancer refractory to standard treatments (tumour agnostic) were responsive to immunotherapy with PD-1 inhibitors, and this really paved the way for immunotherapy approaches for patients with dMMR CRC.⁸

10 years later, we have seen some remarkable data for dual immunotherapy blockade based on the CheckMate 8HW trial results.⁹ The difference in outcomes for patients treated with dual immunotherapy, specifically anti-CTLA-4 plus anti-PD-1, versus the previous standard, chemotherapy, was significant: 

• In the trial, at 24 months progression-free survival was 72% for the dual immunotherapy blockade, compared with 14% for the investigator’s choice of chemotherapy.⁹
• The safety profile for this dual immunotherapy combination also remained consistent with previously reported data and was manageable with established protocols, with no new safety signals identified.⁹

But for me, it's not just about survival outcomes – we need to ensure we personalise discussions with patients and take their wishes into consideration when it comes to choosing treatments. The patient perspective is critical. We want to help them have the best quality of life they can, whilst living with cancer and undergoing treatment.¹⁰

Innovation is important for patients, hospitals, society and the healthcare system as a whole

One of the ways immunotherapies can potentially help improve quality of life for patients is with the integration of subcutaneous formulations, which is the delivery of treatment directly beneath the skin, instead of through an intravenous (IV) infusion.^11,12 

Subcutaneous immunotherapy can shorten administration times to a few minutes, compared to up to 30 minutes with IV administration. This is really meaningful for patients as they can then spend less time in hospital and reclaim precious hours to do things they enjoy – such as spending more time with family and friends and/or maintaining their careers.¹³

From a healthcare provider’s and system perspective, because of increasing pressures such as rising incidence of cancers, varied treatment options, staffing challenges and chemotherapy unit chair time, we recognise the benefits of therapeutic options that can help alleviate the burden on the health service.^14,15,16

Innovative ways of delivery such as subcutaneous immunotherapy are important. Re-thinking how oncology treatments can be administered is good for patients, hospitals, society and how we deliver healthcare as a whole.

Looking ahead

Therapies such as dual immunotherapy and other cancer innovations play an important role in supporting the NHS 10-year plan. Finding innovative ways of developing treatments and delivering care all contribute to improving service delivery and, in the future, could potentially support with shifting care from the hospital to the community.

There is also an important role that the pharmaceutical industry can play in helping support CRC care beyond creating innovative therapies, by helping with education, sharing knowledge, and supporting equitable access to both biomarker testing and therapies.

I do think industry can play a role in working with academics, clinicians, and policymakers to really delve into these pathways, understand how we can make them work better, and support the creation of inclusive care pathways.

2025 has been an exemplary year in CRC. We have a great CRC community and network who are keen to connect and discuss, which is why I think there has been such rapid uptake of innovation within the UK. It is important that we continue to learn and collaborate with each other, and this includes working with our colleagues in other cancer therapy areas with a lot of knowledge and insights that could be shared and adapted in practice.

I remain optimistic about the future of CRC care – not only in terms of therapies that improve survival, but also the collaboration across the national and international oncology community, healthcare professionals, academia, and industry.
 

Prescribing information & adverse events reporting

Prescribing information for nivolumab for infusion can be found here.

Prescribing information for nivolumab for injection can be found here.

Prescribing information for ipilimumab for infusion can be found here.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Bristol Myers Squibb Medical Information on 0800 731 1736 or medical.information@bms.com.

References

1. Bowel Cancer UK. Bowel Cancer. Available at: www.bowelcanceruk.org.uk/about-bowel-cancer/bowel-cancer/. Accessed February 2026.

2. Sung H, et al. Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data. The Lancet Oncology. 2025;26(1):51-63. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00600-4/fulltext

3. Oruç Z and MA Kaplan. Effect of exercise on colorectal cancer prevention and treatment. World J Gastrointest Oncol. 2019;11(5):348-366.

4. Bowel Cancer UK. Targeted Therapy. Available at: https://www.bowelcanceruk.org.uk/about-bowel-cancer/advanced-bowel-cancer/treating-advanced-bowel-cancer/targeted-therapy/ Accessed February 2026.

5. National Cancer Institute. NCI Dictionary of Cancer Terms: dMMR. Available at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/dmmr Accessed February 2026.

6. National Cancer Institute. NCI Dictionary of Cancer Terms: microsatellite instability-high cancer. Available at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/microsatellite-instability-high-cancer. Accessed February 2026.

7. Mulet-Margalef N, Linares J, Badia-Ramentol J, et al. Challenges and therapeutic opportunities in the dMMR/MSI-H colorectal cancer landscape. Cancers (Basel). 2023;15(4):1022. doi:10.3390/cancers15041022.

8. Le DT, Uram JN, Wang H, et al. PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. N Engl J Med. 2015;372(26):2509-2520. doi:10.1056/NEJMoa1500596.

9. Andre T, Elez E, Van Cutsem E, et al. Nivolumab plus Ipilimumab in Microsatellite-Instability–High Metastatic Colorectal Cancer. N Engl J Med. 2024;391:2014-2026.

10. Meropol NJ, Egleston BL, Buzaglo JS, et al. Cancer patient preferences for quality and length of life. Cancer. 2008;113(12):3459-3466. doi:10.1002/cncr.23968

11. Great Ormond Street Hospital for Children NHS Foundation Trust. Giving subcutaneous injections. Available at https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/giving-subcutaneous-injections/. Accessed February 2026.

12. Great Ormond Street Hospital for Children NHS Foundation Trust. Intravenous (IV) infusions. Available at https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/intravenous-iv-infusions/. Accessed February 2026.

13. Scott R. How subcutaneous vs IV may affect treatment adherence in cancer care. CURE. Available at https://www.curetoday.com/view/how-subcutaneous-vs-iv-may-affect-treatment-adherence-in-cancer-care. Accessed February 2026.

14. Charlesworth A, Rachet‑Jacquet L, Rocks S. Short of capacity? Why the government must address the capacity constraints in the English National Health Service. Health Aff Scholar. 2024;2(1). doi:10.1093/haschl/qxad091.

15. Huang YL, Bryce AH, Culbertson T, et al. Alternative Outpatient Chemotherapy Scheduling Method to Improve Patient Service Quality and Nurse Satisfaction. J Oncol Pract. 2018;14(2):e82-e91. doi:10.1200/JOP.2017.025510

16. Huijgens FL, Hillen MA, Huisinga MJ, et al. Cancer Patients’ Experiences of Burden when Involved in Treatment Decision Making. Medical Decision Making. 2025;45(5):533-544. doi:10.1177/0272989X251334979

7356-GB-2600006 | February 2026