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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, dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing), Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2).
Shares KEYNOTE-158, MSI and mismatch-repair testing, dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing).
Shares KEYNOTE-158, dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing), Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma.
Shares MSI and mismatch-repair testing, dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing), Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2).
Shares dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing), Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR).
Shares VENTANA MMR RxDx Panel, MSI and mismatch-repair testing, dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing).
Shares MSI and mismatch-repair testing, dMMR (mismatch repair deficiency by IHC), Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), Mismatch repair & microsatellite instability.
Shares dMMR (mismatch repair deficiency by IHC), MSI-high (microsatellite instability by PCR or sequencing), Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), Mismatch repair & microsatellite instability.