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Prognostic value of mismatch repair deficiency in patients receiving first-line fluoropyrimidine plus platinum for metastatic, recurrent, or unresectable gastric cancer

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Abstract

Background

We examined the impact of mismatch repair (MMR) status on efficacy of first-line fluoropyrimidine plus platinum (FP) chemotherapy in patients with HER2-negative metastatic, recurrent, or unresectable gastric cancer (mGC).

Methods

Patients with mGC receiving first-line FP between 2015 and 2018 at Asan Medical Center, Korea, were reviewed. We evaluated the clinical characteristics and the efficacy of chemotherapy according to MMR status in patients with available immunohistochemistry results.

Results

Of 895 patients, we analyzed 543 with available MMR protein expression results, and deficient MMR (dMMR) was detected in 4.4% (n = 24). Patients with dMMR exhibited a significantly higher median age than those with proficient MMR (pMMR) (64 vs. 58 years, p = 0.044). No signet ring cell carcinoma (SRCC) was detected among dMMR tumors, whereas SRCC was found in 17.5% of pMMR. Objective response rate was 27.3% in dMMR and 34.3% in pMMR (p = 0.556). No difference in progression-free survival was noted between patients with dMMR and pMMR (median, 5.6 vs. 5.8 months, p = 0.266). Patients with dMMR tended to have better overall survival than those with pMMR although this difference was not statistically significant (median, 17.9 vs. 12.2 months, p = 0.183).

Conclusions

Efficacy of first-line FP was not different by MMR status in mGC patients.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This study was presented in part at the 2023 ASCO Gastrointestinal Cancers Symposium.

Funding

None.

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Author notes

  1. Chung Ryul Oh

    Present address: Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea

Authors and Affiliations

  1. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Chung Ryul Oh, Eo Jin Kim, Heejung Chae, Min-Hee Ryu, Hyung-Don Kim & Yoon-Koo Kang

  2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Young Soo Park

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Contributions

Study concepts: Y-KK; data acquisition: EJK, HC, M-HR and Y-KK; quality control of data: CRO, EJK and HC; data analysis and interpretation: CRO, EJK, HC, YSP, M-HR, H-DK and Y-KK; statistical analysis: CRO, EJK and Y-KK; manuscript preparation: CRO, H-DK and Y-KK; manuscript editing: CRO, M-HR, H-DK and Y-KK; manuscript review: CRO, YSP, M-HR, H-DK and Y-KK.

Corresponding author

Correspondence to Yoon-Koo Kang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board (IRB No:2023–1313) of Asan Medical Center, Seoul, Korea. Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous clinical data. This study was performed according to the principles of the Declaration of Helsinki.

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Oh, C.R., Kim, E.J., Chae, H. et al. Prognostic value of mismatch repair deficiency in patients receiving first-line fluoropyrimidine plus platinum for metastatic, recurrent, or unresectable gastric cancer. Gastric Cancer (2024). https://doi.org/10.1007/s10120-024-01483-9

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