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.
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.
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.
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.
microsatellite instability, mismatch repair, immunotherapy, cancers
Received: May 28, 2018
Revision received: June 1, 2018
Accepted after revision: July 17, 2018
BKK Med J 2018;14(2): 1-5.