Treatment of Locally Advanced or Metastatic Ampullary Adenocarcinoma with dMMR / MSI-High Status

Clinical scenario

This protocol addresses locally advanced or metastatic ampullary carcinoma in patients with deficient mismatch repair (dMMR) / MSI-high tumour status and an ECOG performance status of 0–1.

dMMR / MSI-high Locally advanced or metastatic ECOG PS 0–1

Why dMMR / MSI-H status shapes treatment

Deficient mismatch repair (dMMR) or MSI-high status is a defining molecular characteristic that directly influences treatment selection in ampullary carcinoma — the approach for dMMR/MSI-high tumours differs meaningfully from MMR-proficient disease.

Treatment approach — partial overview

Management is guided by the molecular profile of the tumour. For dMMR/MSI-high ampullary carcinoma, immune checkpoint inhibitor (ICI) therapy is a recognised option. Additional targeted strategies are available depending on other molecular alterations — the complete algorithm and its conditions are in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.dld.2024.04.027

For dMMR AC, ICI may be the preferred option (grade C).

For dMMR/MSI-high AC, more common in the INT subtype of AC, ICI might be the preferred first line treatment as for treatment of dMMR metastatic colorectal carcinomas, though no randomized study support this proposition.

For dMMR/MSI-H AC: when not used in first line, ICI is a valid option (grade C).

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