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Pirfenidone + PD-1 inhibitor is an investigational combination therapy being evaluated for the treatment of advanced, refractory proficient mismatch repair/microsatellite stable (pMMR/MSS) colorectal cancer. This regimen combines pirfenidone, a small molecule anti-fibrotic agent, with a programmed cell death protein 1 (PD-1) inhibitor. The rationale behind this combination is that pirfenidone can remodel the immunosuppressive tumor microenvironment, particularly in patients with liver metastases, by reducing fibrosis and potentially converting immunologically "cold" MSS tumors into "hot" tumors that are more responsive to immune checkpoint blockade. This combination is currently being studied in Phase II clinical trials (e.g., NCT06484153) led by researchers at Union Hospital, Tongji Medical College, often in conjunction with hypofractionated radiotherapy.
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