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ASCO Urges Routine dMMR Testing for Second-Line Metastatic Pancreatic Cancer

Jason Harris
Published: Monday, Nov 05, 2018
Davendra Sohal, MD, MPH

Davendra Sohal, MD, MPH

Based on fresh studies in the setting of metastatic pancreatic cancer, the American Society of Clinical Oncology (ASCO) now recommends routine testing for mismatch repair deficiency (dMMR) or high microsatellite instability (MSI-H) for candidates for checkpoint inhibitor therapy.

The changes reflect the ASCO expert panel’s attempt to recommend the appropriate therapy for patients with metastatic pancreatic cancer who experience either disease progression or intolerable toxicity with prior regimens.

Table. Updated ASCO Recommendations for Metastatic Pancreatic Cancer in Second Line

Table. Updated ASCO Recommendations for Metastatic Pancreatic Cancer in Second Line
The updates are based in part by findings of 2 studies. One, a phase II study by Le et al, explored the efficacy of PD-1 inhibition in patients with advanced dMMR cancers across 12 solid tumor types, including pancreatic cancer.2 The other, the phase III PANCREOX trial, evaluated survival outcomes for patients with advanced pancreatic cancer assigned to fluorouracil and oxaliplatin administered as modified FOLFOX6 (mFOLFOX6; infusional fluorouracil, leucovorin, and oxaliplatin) versus fluorouracil plus leucovorin.

Testing for MSI

“For second-line treatment of metastatic pancreatic cancer, our first recommendation now is to consider testing for MSI in patients who are candidates for checkpoint inhibitor therapy,” Davendra Sohal, MD, MPH, director of the Clinical Genomics Program at Cleveland Clinic Taussig Cancer in Ohio and cochair of the expert panel that wrote the new guidelines, said in a podcast. “Any standard form of testing is acceptable, whether immunohistochemistry [IHC], polymerase chain reaction [PCR], or next-gen sequencing.”
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