Hear me out. On paper COMMIT is a "Positive" trial. It is also a spectacular demonstration that Atezolizumab monotherapy should never be used for metastatic MSI-H CRC (we can talk about adjuvant). COMMIT was a randomized first-line study in metastatic MSI-H/dMMR CRC. It began as a 3-arm trial of: • mFOLFOX6/bevacizumab (this sucks) • atezolizumab alone • mFOLFOX6/bevacizumab/atezolizumab After KEYNOTE-177 changed the standard of care, the chemotherapy-only arm closed after 20 patients. The trial continued with 82 patients randomized between atezo alone and the four-drug combination. The headline is that adding FOLFOX/bevacizumab to atezo improved PFS: HR 0.42 Median PFS: 24.5 vs 5.3 months ORR: 86% vs 46% Primary progression: 2.8% vs 32.4% The truth is Atezolizumab PALES in comparison to its contemporary PD1/PDL1 agents in this setting. Single-agent atezo: 12-month PFS 35% 24-month PFS 32% For comparison: Pembrolizumab in KEYNOTE-177: 12-month PFS 55% 24-month PFS 48% Nivolumab in CheckMate 8HW: 12-month PFS 63% 24-month PFS 56% This is not evidence that every patient with metastatic MSI-H CRC needs chemotherapy, bevacizumab, and immunotherapy. It is evidence that NO ONE SHOULD BE USING ATEZOLIZUMAB IN METASTATIC MSI-H CRC. And now, drumroll please… The only positive randomized adjuvant immunotherapy strategy in stage III dMMR colon cancer is ATOMIC: FOLFOX + atezolizumab. That makes COMMIT more than a roast. It raises a important question about ATOMIC. Should we be using Atezolizumab in the adjuvant setting? Do we need to be giving chemotherapy here? Looking forward to what others make of this but this is the real question. @TheGutOncLab @OncoAlert @oncodaily