Mismatch repair deficiency across 12,019 tumors.
The proportion of mismatch repair–deficient
tumors in each cancer subtype is expressed as
a percentage. Mismatch repair–deficient tumors
were identified in 24 of 32 tumor subtypes tested,
more often in early-stage disease (defined as
stage <IV).
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Republished with permission of American Association for the Advancement of Science, from Mismatch repair deficiency
predicts response of solid tumors to PD-1 blockade, Le, 357, 2017; permission conveyed through Copyright Clearance
Center, Inc.
MSI-H = microsatellite instability-high; dMMR = mismatch repair deficient; EGJ =
esophagogastric junction; NSCLC = non–small cell lung cancer.
A CASE FOR KEYTRUDA
IN PATIENTS WITH
ADVANCED
COLON CANCER
SUSIE, A 49-YEAR-OLD FEMALE PATIENT WITH ADVANCED COLON CANCER
Hypothetical patient.
CLINICAL HISTORY
Treatments: Combination chemotherapy + anti-angiogenesis agent until reoccurrence. A different
combination chemotherapy + anti-angiogenesis agent. Three months later, new metastatic lesions were
discovered in lung and liver, unresectable.
Family history: No family history of cancer
ECOG status: 0
Biomarker status: BRAF and KRAS wild type, MSI-H
Diagnosis: Stage IVB colon cancer
ECOG = Eastern Cooperative Oncology Group; BRAF = B-Raf proto-oncogene, serine/threonine kinase; KRAS =
Kirsten rat sarcoma.
Treat appropriate patients with KEYTRUDA.
Hypothetical patient.
A CASE FOR KEYTRUDA
IN PATIENTS WITH ADVANCED
ENDOMETRIAL CANCER
BARBARA, A 62-YEAR-OLD FEMALE PATIENT WITH ADVANCED ENDOMETRIAL CANCER
Hypothetical patient.
CLINICAL HISTORY
Treatments: Initial: Partial conization of the cervix in 2005;
surgery and tumorectomy of all abdominal metastases. Latest: Combination chemotherapy.
ECOG status: 0
Biomarker status: ER 90% positive, PR 90% positive; dMMR
Diagnosis: Stage IVB endometrial cancer
Metastases: Liver, left fallopian tube, right ovary, omentum,
para-aortic lymph nodes
Family history: No family history of cancer
ER = estrogen receptor; PR = progesterone receptor.
Treat appropriate patients with KEYTRUDA.
Hypothetical patient.
A CASE FOR KEYTRUDA
IN PATIENTS WITH ADVANCED
PANCREATIC CANCER
SAM, A 61-YEAR-OLD MALE PATIENT WITH ADVANCED PANCREATIC CANCER
Hypothetical patient.
CLINICAL HISTORY
Treatments: Initial: Stent placed by endoscopic
retrograde cholangiopancreatography (ERCP) followed by
chemotherapy.
Latest: Maintenance therapy with later new
metastatic lesions
ECOG status: 1
Biomarker status: Elevated CA 19-9 levels; unknown
MSI or MMR status
Diagnosis: Stage IV pancreatic cancer
Metastases: Liver and regional lymph nodes
Family history: Aunt with breast cancer
CA = cancer antigen; MSI = microsatellite instability; MMR = mismatch repair.
Test for MSI or MMR status. If MSI-H or dMMR, treat
appropriate patients with KEYTRUDA.
Hypothetical patient.
A CASE FOR KEYTRUDA
IN PATIENTS WITH LYNCH
SYNDROME AND ADVANCED COLON CANCER
ERNESTO, A 29-YEAR-OLD MALE PATIENT WITH LYNCH SYNDROME AND ADVANCED COLON
CANCER
Hypothetical patient.
CLINICAL HISTORY
Treatments: Initial: Surgery and adjuvant chemotherapy
with progression after 5 months.
ECOG status: 1
Biomarker status: RAS and BRAF wild type; germline
mutation in EpCAM; dMMR
Diagnosis: Lynch syndrome with stage IVA colon cancer
Metastases: Unresectable liver metastases and regional
lymph nodes
Family history: Mother with endometrial cancer, ovarian
cancer, and pancreatic cancer; personal history of squamous
cell carcinoma; 22-year-old sister with precancerous colon
polyps who considers herself a previvor
RAS = rat sarcoma; EpCAM = epithelial cell adhesion molecule.
Treat appropriate patients with KEYTRUDA.
Hypothetical patient.
A CASE FOR KEYTRUDA
IN PATIENTS WITH ADVANCED OVARIAN CANCER
SHERYL, A 46-YEAR-OLD FEMALE PATIENT WITH ADVANCED OVARIAN CANCER
Hypothetical patient.
CLINICAL HISTORY
Treatments: Initial: Surgery followed by 6 cycles of
chemotherapy; Sheryl achieved a complete remission for 18
months before CA-125 level began rising. Latest: Secondary
cytoreductive surgery followed by another 6 cycles of
chemotherapy, during which she progressed.
ECOG status: 1
Biomarker status: BRCA negative; unknown MSI or
MMR status
Diagnosis: Stage III ovarian cancer
Metastases: Liver capsule
Family history: No family history of cancer
BRCA = breast cancer susceptibility gene.
Test for MSI or MMR status. If MSI-H or dMMR, treat appropriate patients with
KEYTRUDA.
Hypothetical patient.
A CASE FOR KEYTRUDA
IN PATIENTS WITH ADVANCED PROSTATE CANCER
DANIEL, A 53-YEAR-OLD MALE PATIENT WITH ADVANCED PROSTATE CANCER
Hypothetical patient.
CLINICAL HISTORY
Treatments: Initial: Daniel was at the metastatic castration-resistant
stage. Latest: Due to gradual increase of PSA and
the presence of metastases to the bone and liver, Daniel
continued ADT and started chemotherapy. Six months later,
new lesions in the bone and liver were documented.
ECOG status: 0
Biomarker status: PSA 350; unknown MSI or
MMR status
Diagnosis: Stage IVB mCRPC
Metastases: Bone, liver
Family history: No family history of cancer
PSA = prostate-specific antigen; ADT = androgen deprivation therapy; mCRPC =
metastatic castration-resistant prostate cancer.
Test for MSI or MMR status. If MSI-H or dMMR, treat appropriate patients with
KEYTRUDA.
Hypothetical patient.