{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:28:51Z","timestamp":1786973331047,"version":"build-2736575974"},"reference-count":30,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019757","name":"Gloria Borges WunderGlo Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100019757","id-type":"DOI","asserted-by":"publisher"}]},{"name":"American Cancer Society Institutional Research Grant","award":["ACS-IRG; 2-23-2024"],"award-info":[{"award-number":["ACS-IRG; 2-23-2024"]}]},{"name":"Ming Hsieh Research award","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100006508","name":"Dhont Family Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100006508","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Victoria and Philip Wilson Research Fund","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Daniel Butler Research Fund","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Wright Foundation Trust Transformative Cancer Grant Program","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"National Cancer Institute of the National Institutes of Health","award":["P30CA014089"],"award-info":[{"award-number":["P30CA014089"]}]},{"name":"San Pedro Peninsula Cancer Guild","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Treatment with immune checkpoint inhibitors (ICIs) has radically improved outcomes for patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC). Intrinsic and acquired resistance, however, remains an important concern. Pyrimidine pathway regulates the innate immune response and may offer an opportunity to enhance ICI efficacy via modulation of pyrimidine metabolism. Identification of primary, adaptive and acquired resistance mechanisms and development of actionable strategies to overcome resistance and expand the benefit of ICI is paramount. Our group is the first to show that the dihydropyrimidine dehydrogenase (DPD; gene\n                      <jats:italic>DPYD<\/jats:italic>\n                      ) metabolic pathway predicts the efficacy of ICI in MSI-H tumors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective analysis of germline single nucleotide polymorphisms was done in patients with MSI-H CRC cohort (Veneto Institute of Oncology; OIOV-IRCCS, Padua, Italy) treated with immunotherapy.\n                      <jats:italic>Dpyd<\/jats:italic>\n                      knockout or overexpressed MC38 MSI-H syngeneic mice models were treated with anti-programmed cell death protein 1 (PD-1) and anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4) alone or in combination and their effect on tumor growth and its microenvironment was studied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In our real-world data analysis, genetic variants in\n                      <jats:italic>DPYD<\/jats:italic>\n                      were associated with progression-free survival and tumor response in patients with MSI-H mCRC treated with ICI. In preclinical studies, complete tumor elimination was observed in 100% of mice bearing\n                      <jats:italic>Dpyd<\/jats:italic>\n                      knockout tumors treated with a combination of anti-PD-1 and anti-CTLA-4, further validated by pharmacologically inhibiting DPD using eniluracil.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results showed that the pyrimidine pathway has a strong association with immunotherapy treatment response in CRC. These findings may support the development of novel treatment strategies exploiting DPD inhibition in MSI-H tumors and their quick integration into clinic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jitc-2026-015191","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:05:17Z","timestamp":1786971917000},"page":"e015191","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Dihydropyrimidine dehydrogenase modulates immune response to checkpoint inhibition in mismatch repair deficient\/microsatellite instability-high colorectal cancer"],"prefix":"10.1136","volume":"14","author":[{"given":"Shivani","family":"Soni","sequence":"first","affiliation":[{"name":"Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, California, 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