Do you recommend adjuvant chemotherapy in a patient with node positive gastric adenocarcinoma with mixed dMMR/MSI histology?
What adjuvant therapy would you recommend for a patient with a mixed dMMR and pMMR lymph node positive gastric cancer, who has undergone upfront surgery?
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Well, this is certainly a situation where treatment decisions are completely unburdened by data and one could do virtually anything, from observation to immunotherapy plus chemotherapy.
A more straightforward version of this scenario is if the patient has a fully resected node-positive dMMR/MSI gastric cancer. dMMR/MSI gastric cancers comprise 7-8% of all locally advanced gastric cancers. To our group, the seminal meta-analysis by Pietrantonio and colleagues in the JCO convincingly demonstrates that such tumors have a significantly more favorable prognosis than pMMR/MSS tumors when treated with surgery alone. At the same time, dMMR/MSI tumors either derive no benefit or are harmed by peri-operative chemotherapy. As such, our practice is to p...
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