# Mismatch-repair deficient (MSI-high) colorectal cancer

Source: https://onco.cc/cancers/msi-high-colorectal/  
OnCo record `msi-high-colorectal` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Mismatch-repair deficient bowel cancer has lost its DNA spell-checker, so it carries thousands of mutations that the immune system can recognise. Immunotherapy alone controls most metastatic cases for years and makes most localised tumours disappear before surgery, sometimes so completely that no surgery is needed.

## Summary

Mismatch-repair deficiency arises when MLH1, MSH2, MSH6 or PMS2 is lost, either by sporadic MLH1 promoter methylation (typically right-sided, in older women, often with BRAF V600E) or by a germline mutation in Lynch syndrome, which is why every colorectal cancer is now tested by immunohistochemistry or microsatellite analysis at diagnosis. The tumours accumulate tens of thousands of frameshift mutations, produce abundant neoantigens and are infiltrated by T cells held in check by PD-1; they have a better prognosis when localised and do not benefit from fluorouracil alone as adjuvant therapy.

In metastatic disease KEYNOTE-177 (2020) showed that pembrolizumab alone doubled progression-free survival against chemotherapy (16.5 versus 8.2 months), with 54.8 percent of patients alive at five years and a median survival of 77.5 months; CheckMate 8HW (2024) showed that nivolumab plus ipilimumab cut progression by 79 percent against chemotherapy (median progression-free survival 54.1 versus 5.9 months) and beat nivolumab alone, and the combination was approved first line in April 2025. About a third of patients still progress early, often because of pMMR misclassification, JAK1 or B2M loss or immune-excluded biology.

In localised disease four weeks of neoadjuvant nivolumab and ipilimumab produced pathological complete response in 68 percent of colon cancers in NICHE-2 with no recurrence at three years; the ATOMIC phase 3 trial (2025) showed that adding atezolizumab to adjuvant FOLFOX improves disease-free survival in stage III disease; and in rectal cancer six months of dostarlimab produced a clinical complete response in every patient treated, allowing surgery and radiotherapy to be omitted. For Lynch carriers, colonoscopy every one to two years and daily aspirin (CAPP2) prevent cancers, and frameshift-neoantigen vaccines are in trials.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: dMMR colorectal cancer; MSI-H colorectal cancer; Microsatellite unstable colorectal cancer; Lynch-associated colorectal cancer; Hypermutated colorectal cancer
- Tags: subtype-page
- Group: gastrointestinal
- Burden: About 15 percent of localised and 5 percent of metastatic colorectal cancers have lost DNA mismatch repair, most often through methylation of the MLH1 gene in right-sided tumours of older women and, in about a fifth, through inherited Lynch syndrome.
- Subtypes: Sporadic mismatch-repair deficient (MLH1 promoter methylation, right-sided, often BRAF V600E); Lynch syndrome (germline MLH1, MSH2, MSH6, PMS2 or EPCAM); Localised dMMR colon cancer (neoadjuvant or adjuvant immunotherapy); dMMR rectal cancer (non-operative management with a PD-1 antibody); Metastatic MSI-high colorectal cancer (first-line checkpoint blockade)
- Biomarkers: Mismatch repair immunohistochemistry (MLH1, MSH2, MSH6, PMS2); Microsatellite instability by PCR or sequencing; MLH1 promoter methylation and BRAF V600E (sporadic versus Lynch); Germline testing of mismatch repair genes; Tumour mutational burden; Circulating tumour DNA after curative treatment

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/msi-high-colorectal/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/msi-high-colorectal/#overview [4 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/msi-high-colorectal/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/msi-high-colorectal/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/msi-high-colorectal/#treating-it [4 settings, 3 decisions with options]
- Trials and papers (own page): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/msi-high-colorectal/evidence/ [86 trials, 10 key papers, 7 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/msi-high-colorectal/#science [5 targets, 1 pathway]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/msi-high-colorectal/where-you-are/ [29 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/msi-high-colorectal/#living-with-it [21 questions, 6 red cards, 1 decision aid]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/msi-high-colorectal/coming/ [9 medicines, 86 trials, 3 ideas, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/msi-high-colorectal/data/ [147 connected records]

## Standard of care

- Metastatic, first line: Pembrolizumab alone (KEYNOTE-177) or nivolumab plus ipilimumab (CheckMate 8HW); chemotherapy only if immunotherapy is contraindicated. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [KEYNOTE-177](https://onco.cc/trials/keynote-177/), [CheckMate 8HW](https://onco.cc/trials/checkmate-8hw/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/))
- Localised colon cancer: Neoadjuvant nivolumab plus ipilimumab for locally advanced tumours (NICHE-2) where available; surgery; adjuvant FOLFOX plus atezolizumab for stage III (ATOMIC); no fluoropyrimidine alone. ([NICHE-2](https://onco.cc/trials/niche-2/), [ATOMIC (Alliance A021502)](https://onco.cc/trials/atomic/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/))
- Rectal cancer: Six months of dostarlimab or another PD-1 antibody with non-operative management for complete responders (AZUR-1). ([Dostarlimab](https://onco.cc/drugs/dostarlimab/), [AZUR-1](https://onco.cc/trials/azur-1/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/), [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/))
- Lynch syndrome carriers: Colonoscopy every one to two years from age 25 (earlier for MLH1 and MSH2), daily aspirin (CAPP2), cascade germline testing of relatives, hysterectomy and oophorectomy after childbearing for women. ([Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Aspirin](https://onco.cc/drugs/aspirin/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [CAPP2](https://onco.cc/trials/capp2/))

## State of the art

- First-line immunotherapy without chemotherapy in metastatic disease, with more than half of patients alive at five years in KEYNOTE-177.
- Neoadjuvant checkpoint blockade produces pathological complete response in most localised colon cancers (NICHE-2).
- Rectal cancer can be cured with a PD-1 antibody alone, without surgery or radiotherapy.
- Universal mismatch repair testing at diagnosis finds Lynch families.

## Open problems

- A third of metastatic patients progress early on immunotherapy and the resistance mechanisms are only partly understood.
- Whether surgery can be omitted after complete response in colon, as in rectal, cancer is untested.
- WRN helicase inhibitors, a synthetic-lethal approach, are in early trials.
- Lynch carriers still get cancers between colonoscopies; a preventive vaccine is in randomised testing.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Microsatellite_instability
- Wikipedia: https://en.wikipedia.org/wiki/Microsatellite_instability
- NCCN Guidelines: Colon Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428

## Connected records

- cancers: [Advanced and metastatic small bowel adenocarcinoma](https://onco.cc/cancers/advanced-small-bowel-adenocarcinoma/), [BRAF V600E-mutant colorectal cancer](https://onco.cc/cancers/braf-v600e-colorectal/), [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [HER2-amplified colorectal cancer](https://onco.cc/cancers/her2-amplified-colorectal/), [KRAS G12C-mutant colorectal cancer](https://onco.cc/cancers/kras-g12c-colorectal/), [Lynch syndrome-associated colorectal cancer](https://onco.cc/cancers/lynch-associated-colorectal-cancer/), [Medullary carcinoma of the colon](https://onco.cc/cancers/colorectal-medullary-carcinoma/), [Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma](https://onco.cc/cancers/msi-high-pdac/), [Mucinous adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-mucinous-adenocarcinoma/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/), [Serrated adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-serrated-adenocarcinoma/)
- technologies: [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- targets: [BRAF](https://onco.cc/targets/braf/), [CTLA-4](https://onco.cc/targets/ctla4/), [PD-1](https://onco.cc/targets/pd1/), [WRN helicase (MSI-high cancers)](https://onco.cc/targets/wrn/)
- drugs: [Aspirin](https://onco.cc/drugs/aspirin/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Cadonilimab](https://onco.cc/drugs/cadonilimab/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [EIK1005](https://onco.cc/drugs/eik1005/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- pathways: [Colorectal cancer (KEGG map)](https://onco.cc/pathways/colorectal-cancer-signalling/)
- terms: [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/), [Consensus molecular subtypes (CMS1-4)](https://onco.cc/terms/cms-subtypes/), [CpG island methylator phenotype (CIMP)](https://onco.cc/terms/cimp/), [Immunoscore](https://onco.cc/terms/immunoscore/), [Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [MLH1 promoter methylation (sporadic versus Lynch mismatch repair loss)](https://onco.cc/terms/mlh1-promoter-methylation/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/), [Serrated pathway](https://onco.cc/terms/serrated-pathway/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/), [Watch and wait after chemoradiotherapy for rectal cancer](https://onco.cc/terms/watch-and-wait-rectal-cancer/)
- trials: [- IKF/AIO-QUINTIS - Evaluating Fruquintinib in Combination With Tislelizumab in Microsatellite Stable / Proficient Mismatch Repair (MSS/pMMR) Metastatic Colorec](https://onco.cc/trials/nct06856837/), ["Thymalfasin Immunotherapy Study with Triple Regimen in Advanced MSS/pMMR Colorectal Cancer"](https://onco.cc/trials/nct06829355/), [A Clinical Trial Evaluating the Efficacy and Safety of IBI310 in Combination With Sintilimab, for Neoadjuvant Treatment of MSI-H/dMMR Resectable Colon Cancer](https://onco.cc/trials/nct05890742/), [A Multicenter, Phase Ib/II Clinical Trial to Evaluate the Efficacy and Safety of Concurrent Combination Therapy of S-531011 Plus Fruquintinib or S-531011 Plus F](https://onco.cc/trials/nct07591597/), [A Phase II Study of Tislelizumab as Adjuvant Therapy for Patients With Stage II and Stage III Colon Cancer and dMMR/MSI.](https://onco.cc/trials/nct05231850/), [A Phase IIa Randomized, Double-Blinded Clinical Trial of Naproxen or Aspirin for Cancer Immune Interception in Lynch Syndrome](https://onco.cc/trials/nct05411718/), [A Study of Botensilimab and Balstilimab for Rectal Adenocarcinoma](https://onco.cc/trials/nct06843434/), [A Study of DES-1357 in People With Deficient Mismatch Repair (dMMR)/Microsatellite Instability-High (MSI-H) Metastatic Colorectal Cancer (mCRC)](https://onco.cc/trials/nct07807800/), [A Study of Dostarlimab in Participants With Untreated Locally Advanced Rectal Cancer in China](https://onco.cc/trials/nct06640049/), [A Study of Encorafenib Plus Cetuximab Taken Together With Pembrolizumab Compared to Pembrolizumab Alone in People With Previously Untreated Metastatic](https://onco.cc/trials/nct05217446/), [A Study of HX008 Compared to Chemotherapy in the First-Line Treatment of Subjects With MSI-H/dMMR Metastatic Colorectal Cancer](https://onco.cc/trials/nct05652894/), [A Study of Neoadjuvant QL1706 in Participants With Untreated dMMR/MSI-H Resectable Colon Cancer](https://onco.cc/trials/nct06686576/), [A Study of the Duration of Dostarlimab in Untreated Mismatch Repair Deficient (dMMR)/ Microsatellite Instability-high (MSI-H) Locally Advanced Rectal Cancer](https://onco.cc/trials/nct07740720/), [A Study to Evaluate the Efficacy of VVD-133214 in Combination With Pembrolizumab Compared With Pembrolizumab Alone in Participants With Advanced Cancer of the Colon or Rectum](https://onco.cc/trials/nct07811193/), [A Study to Investigate the Safety and Preliminary Efficacy of GSK5460025 Alone or in Combination With Other Anti-cancer Agents in Participants With Solid Tumors](https://onco.cc/trials/nct07213609/), [A Study to Investigate the Safety, Pharmacokinetics, and Preliminary Effectiveness of GSK4418959 Alone or in Combination With Other Anti-cancer Agents in Participants With Solid Tumors](https://onco.cc/trials/nct06710847/), [Adjuvant PD-1 Blockade for High-risk Stage-II DMMR/MSI-H Colorectal Cancer](https://onco.cc/trials/nct06520683/), [Anti-PCSK9 Antibody Tafolecimab and Anti-PD-1 Antibody Sintilimab Combined With Neoadjuvant Chemoradiotherapy for pMMR/ MSS Locally Advanced Rectal Cancer : A P](https://onco.cc/trials/nct07686796/), [ATOMIC (Alliance A021502)](https://onco.cc/trials/atomic/), [AZUR-1](https://onco.cc/trials/azur-1/), [Brachytherapy Followed by Nivolumab Prior to Surgery in Rectal Cancer](https://onco.cc/trials/nct07645118/), [CAPP2](https://onco.cc/trials/capp2/), [Cemiplimab With or Without Fianlimab to Treat Older Patients With Localized or Locally Advanced MSI-H Colorectal Cancer](https://onco.cc/trials/nct06205836/), [CheckMate 142](https://onco.cc/trials/checkmate-142/), [CheckMate 8HW](https://onco.cc/trials/checkmate-8hw/), [Combination of High and Low-Dose Radiotherapy With Immune Therapy and TKI in Advanced Colorectal Cancer: A Phase II Study](https://onco.cc/trials/nct07467590/), [Combining DCSZ11 With Radiation and Chemotherapy as Neoadjuvant Treatment for pMMR Locally Advanced Rectal Cancer](https://onco.cc/trials/nct07580339/), [Comparison of In-Home Versus In-Clinic Administration of Subcutaneous Nivolumab Through Cancer CARE (Connected Access and Remote Expertise) Beyond Walls (CCBW)](https://onco.cc/trials/nct06265285/), [DETERMINE Trial Treatment Arm 02: Atezolizumab in Adult, Paediatric and Teenage/Young Adult Patients With Cancers With High Tumour Mutational Burden (TMB) or Mi](https://onco.cc/trials/nct05770102/), [Different Cycles of Preoperative Neoadjuvant Sintilimab in Mismatch-repair Deficient/microsatellite Instability-high, Locally Advanced Colorectal Cancer](https://onco.cc/trials/nct06698757/), [Effect of Chemoprevention by Low-dose Aspirin of New or Recurrent Colorectal Adenomas in Patients With Lynch Syndrome](https://onco.cc/trials/nct02813824/), [EIK1005-002: A Clinical Research Study Evaluating EIK1005, a Werner Helicase Inhibitor, as Monotherapy and in Combination With Pembrolizumab in Partic](https://onco.cc/trials/nct07262619/), [Evaluating the Impact of GLP-1 Receptor Agonists With Total Neoadjuvant Therapy in Rectal Cancer](https://onco.cc/trials/nct07314528/), [Evaluation of Co-formulated Pembrolizumab/Quavonlimab (MK-1308A) Versus Other Treatments in Participants With Microsatellite Instability-High (MSI-H) ](https://onco.cc/trials/nct04895722/), [Finding the Best Dose of Aspirin to Prevent Lynch Syndrome Cancers](https://onco.cc/trials/nct02497820/), [Fruquintinib Plus Camrelizumab and HAIC in the Treatment of Non-MSI-H Advanced Colorectal Cancer](https://onco.cc/trials/nct06423937/), [Futibatinib in Combination With (Chemo)Immunotherapy in Colorectal Cancer and Other Solid Tumor Entities](https://onco.cc/trials/nct06722183/), [Immune Checkpoint Inhibitors for Organ Preservation in Non-metastatic dMMR/MSI-H Gastric or Colon Cancers](https://onco.cc/trials/nct06580574/), [Immunotherapy (Toripalimab) for Reducing Recurrence Risk After Surgery for Mismatch Repair Deficient Stage IIB, IIC, or III Colon Cancer](https://onco.cc/trials/nct07140679/), [Immunotherapy in Patients With Early dMMR Rectal Cancer](https://onco.cc/trials/nct05732389/), [KEYNOTE-177](https://onco.cc/trials/keynote-177/), [Low Dose, Reduced Frequency Nivolumab for the Treatment of Unresectable or Metastatic Cancer, AFFORD IO Trial](https://onco.cc/trials/nct07576725/), [Low-dose Immunotherapy in Metastatic and Locally Advanced Colorectal and Gastric MSI/dMMR Cancers](https://onco.cc/trials/nct07542262/), [Mesalamine for Colorectal Cancer Prevention Program in Lynch Syndrome](https://onco.cc/trials/nct04920149/), [Neoadjuvant Chemoradiotherapy Combined With Immunotherapy and Anti-angiogenesis in Treating Locally Advanced Rectal Cancer](https://onco.cc/trials/nct07134218/), [Neoadjuvant Chemotherapy, Excision And Observation vs Chemoradiotherapy For Rectal Cancer](https://onco.cc/trials/nct06205485/), [Neoadjuvant Immunotherapy ± Radiotherapy in MSI-H/dMMR Locally Advanced Colorectal Cancer](https://onco.cc/trials/nct07403877/), [Neoadjuvant Immunotherapy and Organ-sparing Treatment in Patients With Stage I-III dMMR Colon Cancer](https://onco.cc/trials/nct07409844/), [Neoadjuvant Moderately Hypofractionated Radiotherapy Combined With Chemotherapy and Immunotherapy for High-risk pMMR/MSS Locally Advanced Rectal Cancer: A Prosp](https://onco.cc/trials/nct07527520/), [Neoadjuvant Pembrolizumab and Porustobart in Resectable pMMR/MSS Colon Cancer](https://onco.cc/trials/nct07808151/), [Neoadjuvant Pembrolizumab With a Watch-and-wait Strategy for dMMR/MSI-H Localized Colon Cancer: PREMICES Study.](https://onco.cc/trials/nct06646445/), [Neoadjuvant Therapy for Locally Advanced Low Rectal Cancer (SMARTi-RC01)](https://onco.cc/trials/nct07134101/), [Neoadjuvant Toripalimab With or Without Celecoxib in dMMR/MSI-H Colorectal Cancer](https://onco.cc/trials/nct03926338/), [Neoadjuvant/Adjuvant AK104 in Microsatellite Instability-high or Mismatch Repair-deficient, Resectable Colon Cancer](https://onco.cc/trials/nct07412613/), [NICHE-2](https://onco.cc/trials/niche-2/), [Nivolumab and Ipilimumab in Anti-PD1-Resistant dMMR/MSI mCRC](https://onco.cc/trials/nct05310643/), [Optimizing Immunotherapy Combined With Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer](https://onco.cc/trials/nct07040098/), [PACE: PD-1 Antibody For dMMR/MSI-H Stage III Colorectal Cancer](https://onco.cc/trials/nct05236972/), [Patient Preference for Subcutaneous vs. Intravenous Immune Therapy](https://onco.cc/trials/nct07223424/), [Pembrolizumab With Ataluren in Patients With Metastatic pMMR and dMMR Colorectal Carcinoma or Metastatic dMMR Endometrial Carcinoma: the ATAPEMBRO Study](https://onco.cc/trials/nct04014530/), [Phase II Clinical Trial of Cadonilimab Combined With Anti-angiogenic Agents in Metastatic dMMR/MSI-H CRC](https://onco.cc/trials/nct07003022/), [Phase II Open-label Trial of Neoadjuvant Immunochemotherapy for Resectable Non-metastatic Colon cancER: NICER](https://onco.cc/trials/nct05870800/), [Preoperative Chemoradiotherapy With CApecitabine and Temozolomide in MGMT Silenced, MSS, Locally Advanced RecTal Cancer](https://onco.cc/trials/nct05136326/), [PRODIGE 90 - (FFCD 2204) Neoadjuvant Dostarlimab with Short Course Radiotherapy in a Watch-and-wait Strategy for Microsatellite Unstable or Mismatch Repair-defi](https://onco.cc/trials/nct06762405/), [QL1706 Plus Bevacizumab for Unresectable or Metastatic MSI-H/dMMR CRC](https://onco.cc/trials/nct07009145/), [QL1706 With Short-Course Radiotherapy and Chemotherapy for MSS Rectal Cancer](https://onco.cc/trials/nct07175636/), [RECTIFY-1: Neoadjuvant Botensilimab + Balstilimab in MSS/pMMR Early Rectal Cancer](https://onco.cc/trials/nct07735624/), [Regorafenib in Combination With Multimodal Metronomic Chemotherapy for Chemo-resistant Metastatic Colorectal Cancers](https://onco.cc/trials/nct06425133/), [Safety and Efficacy of PD-1 ± mFOLFOX6 Neoadjuvant Therapy in Local Advanced sMPCC](https://onco.cc/trials/nct06002789/), [SCRT Followed by AK112 in pMMR/MSS Mid-low Rectal Cancer](https://onco.cc/trials/nct07162714/), [SCRT-CAPEOX-Serplulimab for MSS/pMMR Rectal Cancer With Oligometastases](https://onco.cc/trials/nct06850103/), [Serplulimab Combined With CAPEOX + Celecoxib as Neoadjuvant Treatment for Locally Advanced Rectal Cancer](https://onco.cc/trials/nct05731726/), [Single Arm Study of Neoadjuvant Dostarlimab in Stage II and III Deficient Mismatch Repair Colon Cancers](https://onco.cc/trials/nct05239546/), [Single cEll pRofiling PErsistaNce To ImmuNothErapy](https://onco.cc/trials/nct06680739/), [Single-arm, Phase II Clinical Study Evaluating the Safety and Efficacy of Sintilimab Combined With IBI-310 and Chemotherapy as Neoadjuvant Therapy for Locally A](https://onco.cc/trials/nct07750951/), [Study of Pembrolizumab (MK-3475) Versus Chemotherapy in Chinese Participants With Stage IV Colorectal Cancer (MK-3475-C66)](https://onco.cc/trials/nct05239741/), [Study of Perioperative Dostarlimab in Participants With Untreated T4N0 or Stage III dMMR/MSI-H Resectable Colon Cancer](https://onco.cc/trials/nct05855200/), [Study on the Efficacy and Safety of Neoadjuvant Radiotherapy Combined With Tislelizumab, Liposomal Irinotecan, and Capecitabine in the Treatment of pMMR Locally](https://onco.cc/trials/nct07104604/), [Testing Ivonescimab in Combination With Chemotherapy in Patients With Metastatic Colorectal Cancers Without Liver Metastases](https://onco.cc/trials/nct07359456/), [Testing the Addition of an Anti-Cancer Drug, Irinotecan, to the Standard Chemotherapy Treatment (FOLFOX) After Long-Course Radiation Therapy for Advanced-Stage](https://onco.cc/trials/nct05610163/), [Testing the Addition of Atezolizumab to Combination Chemotherapy or Atezolizumab Alone for Metastatic Colon or Rectal Cancer, the COMMIT Study](https://onco.cc/trials/nct02997228/), [Testing the Combination of the Anti-Cancer Drugs Temozolomide and M1774 to Evaluate Their Safety and Effectiveness](https://onco.cc/trials/nct05691491/), [The Study of JMT101 Combined With Irinotecan as a ≥3rd-Line Treatment in Metastatic Colorectal Cancer](https://onco.cc/trials/nct07134205/), [Tislelizumab Combined With Chemotherapy (CAPOX) in the Perioperative Treatment of MSI-H/dMMR Stage II or III Colorectal Cancer](https://onco.cc/trials/nct05841134/), [Toripalimab Plus Celecoxib for dMMR/MSI-H Locally Advanced Colorectal Cancer](https://onco.cc/trials/nct06903858/), [XELOX Plus DoSTARlimab Versus XELOX Alone as Consolidation Treatment After Standard Chemoradiation in pMMR/MSS or MSI-Low Locally Advanced Rectal Cancer (LARC)](https://onco.cc/trials/nct07381777/)
- people: [Andrea Cercek](https://onco.cc/people/andrea-cercek/), [Heinz-Josef Lenz](https://onco.cc/people/heinz-josef-lenz/), [Luis A. Diaz Jr.](https://onco.cc/people/luis-diaz/), [Thierry André](https://onco.cc/people/thierry-andre/)
- key papers: [CAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years](https://onco.cc/key-papers/paper-capp2-aspirin-lynch-lancet-2020/), [Cercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency](https://onco.cc/key-papers/paper-cercek-dostarlimab-rectal-nejm-2022/), [CheckMate 8HW: nivolumab plus ipilimumab versus nivolumab alone in MSI-high metastatic colorectal cancer](https://onco.cc/key-papers/paper-checkmate-8hw-lancet-2025/), [Comprehensive molecular characterization of human colon and rectal cancer](https://onco.cc/key-papers/paper-tcga-colorectal-comprehensive-characterization-nature-2012/), [KEYNOTE-177: pembrolizumab instead of chemotherapy as first treatment for mismatch-repair-deficient metastatic colorectal cancer](https://onco.cc/key-papers/paper-keynote-177-nejm-2020/), [Le 2015: PD-1 blockade works in tumours with mismatch-repair deficiency, whatever the organ](https://onco.cc/key-papers/paper-le-mmr-deficiency-pd1-nejm-2015/), [Le 2017: mismatch-repair deficiency predicts response to PD-1 blockade across twelve tumour types, leading to the first tissue-agnostic drug approval](https://onco.cc/key-papers/paper-le-mmr-deficiency-science-2017/), [NICHE-2: a month of nivolumab and ipilimumab before surgery clears mismatch-repair-deficient colon cancer in most patients](https://onco.cc/key-papers/paper-niche-2-nejm-2024/), [Nivolumab plus ipilimumab in microsatellite-instability-high metastatic colorectal cancer (CheckMate 8HW)](https://onco.cc/key-papers/paper-andre-checkmate-8hw-nivolumab-ipilimumab-nejm-2024/), [Nonoperative management of mismatch repair-deficient tumors](https://onco.cc/key-papers/paper-cercek-nonoperative-management-mismatch-repair-deficient-tumours-nejm-2025/)
- ideas: [A randomised trial of a shared-antigen vaccine to prevent Lynch syndrome cancers](https://onco.cc/ideas/idea-prev-lynch-frameshift-vaccine-rct/), [Get every Lynch syndrome carrier onto the right dose of aspirin](https://onco.cc/ideas/idea-prev-lynch-aspirin-implementation/), [WRN inhibitors: a second synthetic-lethal win for mismatch-repair cancers](https://onco.cc/ideas/idea-bio1-wrn-msi-programme/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)

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JSON: https://onco.cc/api/v1/entities/msi-high-colorectal.json