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Pooling 34 studies and 8,323 patients, this review put mismatch repair deficient pancreatic cancer at about 1 to 2%, typically with medullary or colloid appearance and without the usual KRAS and TP53 mutations, and recommended testing those histologies.
PubMed, SCOPUS and Embase were searched to November 2019 for MSI or mismatch repair deficiency in pancreatic ductal adenocarcinoma; 34 studies with 8,323 patients were included and compared with SEER and TCGA references. MSI/dMMR had a very low prevalence, around 1 to 2%, and was strongly associated with medullary and mucinous/colloid histology and with a KRAS/TP53 wild-type background with commoner JAK gene mutations; survival data were unclear. The authors recommend routine testing of medullary or colloid tumours by immunohistochemistry followed by MSI PCR where doubtful, and next-generation sequencing where tissue is limited or profiling is being done anyway.
It tells the pathologist which pancreatic cancers to test for the one immunotherapy-responsive subgroup and how.
Shares MSI and mismatch-repair testing, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing).
Shares KEYNOTE-158, MSI and mismatch-repair testing, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), dMMR (mismatch repair deficiency by IHC).
Shares KEYNOTE-158, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing).
Shares VENTANA MMR RxDx Panel, MSI and mismatch-repair testing, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), MSI-high (microsatellite instability by PCR or sequencing).
Shares Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing), Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR).
Shares Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), MSI-high (microsatellite instability by PCR or sequencing), Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR).
Shares MSI and mismatch-repair testing, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), dMMR (mismatch repair deficiency by IHC), Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR).
Shares MSI and mismatch-repair testing, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR).