Thank you for posting this news, JFL. It makes sense to me to look at mutations and not just location. One of my VUS (Variants of Unknown Significance) on F1 appears to be significant in colon cancer, so why not, at some point, consider the drugs used in that setting?

I believe MSI-H and dMMR refer to categories rather than being names of particular genes and mutations. For example, MLH1, MSH2, MSH6, and PMS2 are all mismatch repair genes that F1 assays.

My genetics counselor said that having one of these mutations show up in the breast tumor --it's actually a germline mutation -- did not make it a micro-satellite unstable tumor. But if subsequent testing reveals more such mutations in the categories mentioned above, then they would consider a PD-1 inhibitor for me. It brings hope to see advances in personalized cancer treatment.

JFL- Wow, really! that is great news! I remember reading quite awhile back that where the best response rates for the most sensitive of cancers to immunotherapy is maybe only 15-25%, if the cancer has mutations in the mismatch DNA repair pathway (ie, mutaions in the mismatch DNA repair -MSH-proteins), then 67% of those cancers respond to immunotherapy. So it makes sense that FDA would open up immuno to anyone with a cancer having that defect.

But where it gets further interesting is that some drugs may introduce mutations or loss of expression of mismatch DNA repair proteins. Some CDK inhibitors might do this, for example (but not Ibrance, to my knowledge)- so, if any drugs are identified that block the expression of the MSH proteins, that drug would enable a cancer with normal MSH proteins to become sensitive to immunotherapy. So now a big search in pharma for drugs that affect the expression or activity of the MSH proteins!

https://www.sciencedaily.com/releases/2017/05/170523124122.htm

Immunotherapy target suppresses pain to mask cancer

I am in a phase II trial in Portland Oregon for TNBC mets to lymph nodes (stage 4) and have been on pembrolizumab (Keytruda) since December...infusion every three weeks with concurrent chemo of Xeloda one week on one week off. I didn't have foundation one testing done prior to getting enrolled in this trial but what "appears" to be happening is the cancer is traveling node to node and where it gets knocked out, it does not appear to be returning. I have whole sections of my neck that do no light up on PET scan anymore that did in October of 2016. I do have NEW nodes that light up now but my immune system appears to be keeping the cancer within my lymph system and is not allowing it to escape.