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Journal of Cancer Research and Clinical Oncology

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Open Access 01-01-2021 | Colorectal Cancer | Original Article – Clinical Oncology

Clinical responses to PD-1 inhibition and their molecular characterization in six patients with mismatch repair-deficient metastatic cancer of the digestive system

Authors: Daniela Hirsch, Timo Gaiser, Kirsten Merx, Simone Weingaertner, Michael Forster, Alexander Hendricks, Matthias Woenckhaus, Thomas Schubert, Ralf-Dieter Hofheinz, Deniz Gencer

Published in: Journal of Cancer Research and Clinical Oncology | Issue 1/2021

Abstract

Purpose

Immune checkpoint inhibitors have shown efficacy in patients with microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) gastrointestinal (GI) cancers. However, depth and duration of clinical response is not uniform. We assessed tumor mutation burden (TMB) as a response marker in patients with GI cancers treated with immune checkpoint inhibitors.

Methods

Detailed clinical and response data were collected from six patients with metastatic MSI-H/dMMR GI cancers treated with immune checkpoint inhibitors. Efficacy was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Tumors and matched normal tissue were profiled by targeted next generation sequencing (127 gene panel, size 0.8 Mb). Impact of included mutation types, germline filtering methodology and different variant allele frequency thresholds on TMB estimation was assessed.

Results

Objective radiographic responses were observed in all six patients, and complete response was achieved in two of the six patients. Responses were durable (minimum 25 months). TMB estimates were clearly above the two recently reported cut-offs for metastatic colorectal cancer of 12 or 37 mutations per megabase for five of six patients, respectively, while one patient had borderline TMB elevation. TMB did not show an association with extent and duration of response but was influenced by included mutation types, germline filtering method and variant allele frequency threshold.

Conclusion

Our case series confirms the clinical benefit of immune checkpoint blockade in patients with metastatic MSI-H/dMMR GI cancers and illustrates the vulnerability of TMB as predictive marker in a subset of patients.

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Title: Clinical responses to PD-1 inhibition and their molecular characterization in six patients with mismatch repair-deficient metastatic cancer of the digestive system
Authors: Daniela Hirsch
Timo Gaiser
Kirsten Merx
Simone Weingaertner
Michael Forster
Alexander Hendricks
Matthias Woenckhaus
Thomas Schubert
Ralf-Dieter Hofheinz
Deniz Gencer
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Colorectal Cancer
Colorectal Cancer
Checkpoint Inhibitors
Published in: Journal of Cancer Research and Clinical Oncology / Issue 1/2021
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-020-03335-2

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