美国食品和药物管理局(FDA)批准免疫检查点抑制剂治疗晚期实体瘤患者具有DNA错配修复缺陷或高水平的微卫星不稳定性;然而,FDA没有提供关于应使用哪些特定的临床试验来确定错配修复状态的指导.
制定循证指南,以确定最佳的临床实验室测试,以确定正在考虑进行免疫检查点抑制剂治疗的实体瘤恶性肿瘤患者的DNA错配修复缺陷。
美国病理学家学会召集专家小组对文献进行系统回顾并提出建议。使用美国国家医学院认可的建议评估分级,开发和评估方法,这些建议是从现有证据中得出的,证据的强度,开放评论反馈,和专家小组共识。错配修复免疫组织化学,微卫星不稳定性来自聚合酶链反应和下一代测序,和来自大小组下一代测序的肿瘤突变负担在范围内。
提出了6项建议和3项良好做法声明。与胃肠道外的癌症相比,结直肠癌和其他胃肠道(GI)癌症的质量更高。
最佳测定取决于癌症类型。对于胃肠道和子宫内膜以外的大多数癌症类型,没有足够的公开证据推荐特定的临床检测方法.没有公开的证据,免疫组织化学是大多数临床实验室都可以接受的方法。
The US Food and Drug Administration (FDA) approved immune checkpoint inhibitor therapy for patients with advanced solid tumors that have DNA mismatch repair defects or high levels of microsatellite instability; however, the FDA provided no guidance on which specific clinical assays should be used to determine mismatch repair status.
To develop an evidence-based
guideline to identify the optimal clinical laboratory test to identify defects in DNA mismatch repair in patients with solid tumor malignancies who are being considered for immune checkpoint inhibitor therapy.
The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Using the National Academy of Medicine-endorsed Grading of Recommendations Assessment, Development and Evaluation approach, the recommendations were derived from available evidence, strength of that evidence, open comment feedback, and expert panel
consensus. Mismatch repair immunohistochemistry, microsatellite instability derived from both polymerase chain reaction and next-generation sequencing, and tumor mutation burden derived from large panel next-generation sequencing were within scope.
Six recommendations and 3 good practice statements were developed. More evidence and evidence of higher quality were identified for colorectal cancer and other cancers of the gastrointestinal (GI) tract than for cancers arising outside the GI tract.
An optimal assay depends on cancer type. For most cancer types outside of the GI tract and the endometrium, there was insufficient published evidence to recommend a specific clinical assay. Absent published evidence, immunohistochemistry is an acceptable approach readily available in most clinical laboratories.