TY - JOUR
T1 - MSI-Testung
T2 - Was ist neu? Was ist zu beachten?
AU - Rüschoff, Josef
AU - Baretton, Gustavo
AU - Bläker, Hendrik
AU - Dietmaier, Wolfgang
AU - Dietel, Manfred
AU - Hartmann, Arndt
AU - Horn, Lars Christian
AU - Jöhrens, Korinna
AU - Kirchner, Thomas
AU - Knüchel, Ruth
AU - Mayr, Doris
AU - Merkelbach-Bruse, Sabine
AU - Schildhaus, Hans Ulrich
AU - Schirmacher, Peter
AU - Tiemann, Markus
AU - Tiemann, Katharina
AU - Weichert, Wilko
AU - Büttner, Reinhard
N1 - Publisher Copyright:
© 2021, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
PY - 2021/7
Y1 - 2021/7
N2 - Based on new trial data regarding immune checkpoint inhibitors (ICIs), the detection of high-grade microsatellite instability (MSI-H) or underlying deficient mismatch repair protein (dMMR) is now becoming increasingly important for predicting treatment response. For the first time, a PD‑1 ICI (pembrolizumab) has been approved by the European Medicines Agency (EMA) for first-line treatment of advanced (stage IV) dMMR/MSI‑H colorectal cancer (CRC). Further indications, such as dMMR/MSI‑H endometrial carcinoma (EC), have already succeeded (Dostarlimab, 2nd line treatment) and others are expected to follow before the end of 2021. The question of optimal testing in routine diagnostics should therefore be re-evaluated. Based on a consideration of the strengths and weaknesses of the widely available methods (immunohistochemistry and PCR), a test algorithm is proposed that allows quality assured, reliable, and cost-effective dMMR/MSI‑H testing. For CRC and EC, testing is therefore already possible at the primary diagnosis stage, in line with international recommendations (NICE, NCCN). The clinician is therefore enabled from the outset to consider not only the predictive but also the prognostic and predispositional implications of such a test when counseling patients and formulating treatment recommendations. As a basis for quality assurance, participation in interlaboratory comparisons and continuous documentation of results (e.g., QuIP Monitor) are strongly recommended.
AB - Based on new trial data regarding immune checkpoint inhibitors (ICIs), the detection of high-grade microsatellite instability (MSI-H) or underlying deficient mismatch repair protein (dMMR) is now becoming increasingly important for predicting treatment response. For the first time, a PD‑1 ICI (pembrolizumab) has been approved by the European Medicines Agency (EMA) for first-line treatment of advanced (stage IV) dMMR/MSI‑H colorectal cancer (CRC). Further indications, such as dMMR/MSI‑H endometrial carcinoma (EC), have already succeeded (Dostarlimab, 2nd line treatment) and others are expected to follow before the end of 2021. The question of optimal testing in routine diagnostics should therefore be re-evaluated. Based on a consideration of the strengths and weaknesses of the widely available methods (immunohistochemistry and PCR), a test algorithm is proposed that allows quality assured, reliable, and cost-effective dMMR/MSI‑H testing. For CRC and EC, testing is therefore already possible at the primary diagnosis stage, in line with international recommendations (NICE, NCCN). The clinician is therefore enabled from the outset to consider not only the predictive but also the prognostic and predispositional implications of such a test when counseling patients and formulating treatment recommendations. As a basis for quality assurance, participation in interlaboratory comparisons and continuous documentation of results (e.g., QuIP Monitor) are strongly recommended.
KW - DNA mismatch repair
KW - Endometrial carcinoma
KW - Immune checkpoint inhibitors
KW - Microsatellite instability
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85104155848&partnerID=8YFLogxK
U2 - 10.1007/s00292-021-00944-7
DO - 10.1007/s00292-021-00944-7
M3 - Übersichtsartikel
C2 - 34043067
AN - SCOPUS:85104155848
SN - 0172-8113
VL - 42
SP - 414
EP - 423
JO - Pathologe
JF - Pathologe
IS - 4
ER -