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Published on: September 1, 2019
Microsatellite instability: A 2024 update
Hiroyuki Yamamoto1,2, Yoshiyuki Watanabe2,3, Hiroyuki Arai4
1Department of Bioinformatics, St. Marianna University Graduate School of Medicine, Kawasaki, Japan.
Deficient mismatch repair (dMMR) causes microsatellite instability (MSI), a key biomarker for advanced cancers. MSI-H/dMMR status guides eligibility for immune checkpoint inhibitors (ICIs) and informs novel therapeutic strategies.
Area of Science:
- Oncology
- Genomics
- Immunotherapy
Background:
- Deficient mismatch repair (dMMR) leads to microsatellite instability (MSI), a significant mutator phenotype.
- High-frequency MSI (MSI-H)/dMMR is a crucial biomarker for advanced cancer patients, guiding eligibility for immune checkpoint inhibitors (ICIs).
Purpose of the Study:
- To provide an update on MSI-driven carcinogenesis.
- To emphasize unique landscapes of diagnostic and immunotherapeutic strategies for MSI-H malignancies.
Main Methods:
- Next-generation sequencing (NGS) based methods for assessing MSI status.
- Comprehensive genomic profiling (CGP) for precise MSI status and genomic alteration ascertainment.
- Liquid biopsy-based CGP assays for MSI status determination.
Main Results:
- MSI-H identified across various tumor types, increasing immunotherapy adoption.
- NGS studies characterized MSI-driven carcinogenesis, revealing fusion kinases in MSI-H colorectal cancers (CRCs).
- Novel diagnostic and therapeutic techniques, including synthetic lethal therapy targeting the Werner gene, are emerging.
Conclusions:
- MSI status and associated genomic alterations hold clinical relevance for malignancy diagnosis and treatment.
- DNA sensing in dMMR cancer cells is vital for immunotherapy, revealing new avenues and biomarkers.
- Understanding MSI-driven carcinogenesis is key for developing advanced immunotherapeutic strategies.
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