Electronic ISSN 2287-0237

VOLUME

INCREASING DEMAND FOR MSI TESTING AND PREVALENCE OF MSI-H CANCERS IN THAI PATIENTS: EXPERIENCE AT CHULALONGKORN GENEPRO CENTER

SEPTEMBER 2018 - VOL.14 | ORIGINAL ARTICLE
RATIONALE:

Loss of DNA mismatch repair function has long been known in various malignancies, particularly colorectal cancer. However, microsatellite instability (MSI) testing was rarely requested in Thailand. Recently, the US Food and Drug Administration (FDA) has approved pembrolizumab, an antibody to PD-1 receptor, as an alternative treatment for high MSI (MSI-H) and/or MMR (mismatch repair)-deficient solid tumors. We report our recent observation on MSI testing in Thailand.

MATERIALS AND METHODS:

Data was collected from Chulalongkorn GenePRO Center, Faculty of Medicine, Chulalongkorn University, during July 2013 and July 2017. MSI testing was performed, using 5 microsatellite markers (BAT-25, BAT-26, D2S123, D5S346 and D17S250). The number, source, and result of samples underwent MSI assay were analyzed.

RESULTS:

Requests for MSI testing have increased significantly in recent years. The shift started in 2015 when the MMR status was found to predict clinical benefit with the immune checkpoint blockade. There were 118 (75.2%) colorectal, 11 (7%) gastric, and 28 (17.8%) other cancers tested. MSI-H, MSI-L, and microsatellite stable (MSS) tumors were detected in 18 (11.5%), 11 (7%), and 128 (81.5%) patients, respectively. Of the 18 MSI-H cancers; 13 (72.2%), 4 (22.2%), and 1 (5.6%) were colorectal, gastric, and gynecologic malignancy, respectively. BAT25 and BAT26 markers were unstable in all MSI-H tumors.

CONCLUSION:

We have experienced increasing demand for MSI testing in Thai patients at Chulalongkorn GenePRO Center. Colorectal cancers were most frequently tested, and accounted for the highest percentage among the MSI-H cancers.

Keywords:

microsatellite instability, mismatch repair, immunotherapy, cancers

Address Correspondence to author:

Chinachote Teerapakpinyo, PhD

Chulalongkorn GenePRO Center,Faculty of Medicine, Chulalongkorn University 1873, Rama 4 Rd., Pathumwan, Bangkok 10330, Thailand.

email: Chinachote.T@chula.ac.th

Received: May 28, 2018

Revision received: June 1, 2018

Accepted after revision: July 17, 2018

BKK Med J 2018;14(2): 1-5.

DOI: 10.31524/bkkmedj.2018.09.001

MEDIA
Table 1: Characteristics of patients related to the samples used in this study (n = 157)
Figure 1: Trend of MSI testing at King Chulalongkorn Memorial Hospital and private hospitals.
Figure 2: Representative fragment analysis of 5 microsatellite loci are shown (A-E), all demonstrating microsatellite instability (N = normal DNA, and T = tumor DNA).
Table 2: Frequency of cancer locations in MSI-L and MSI-H subgroups
Table 3: Instability of each microsatellite marker in 10 MSI-L and 17 MSI-H tumors
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