Treatment of Metastatic Pancreatic Cancer with Microsatellite Instability-High (MSI-H) / Mismatch Repair Deficient (dMMR) Tumour

A clinically important subset of patients with metastatic pancreatic cancer carry tumours characterised by microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR) — a molecular finding that directly informs treatment selection.

Clinical scenario

Metastatic MSI-H dMMR

This protocol addresses metastatic pancreatic cancer in patients whose tumour tests positive for microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR) status. Molecular tumour testing is required to identify eligibility for this treatment pathway.

Treatment approach — partial overview

In the MSI-H / dMMR setting, pembrolizumab is among the agents that may be considered, proposed in the second- or later-line context. The complete regimen, full eligibility criteria, and treatment sequencing are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2023.08.009

In patients with MSI-H/dMMR pancreatic tumours, pembrolizumab can be proposed as second- or later-line treatment [II, B; ESMO-MCBS v1.1 score: 3; ESCAT score: I-C; FDA approved; not EMA approved as a dMMR/MSI-H tumour-agnostic indication but for specific tumour types (excludes PC)].

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