scholarly journals 272 Dostarlimab in advanced/recurrent mismatch repair deficient/microsatellite instability high or proficient/stable endometrial cancer: the GARNET study

2021 ◽  
Author(s):  
A Oaknin ◽  
L Gilbert ◽  
AV Tinker ◽  
J Brown ◽  
C Mathews ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Microsatellite Instability ◽  
Mismatch Repair

scholarly journals Understanding Inherited Risk in Unselected Newly Diagnosed Patients With Endometrial Cancer

2019 ◽  
pp. 1-15
Author(s):  
Karen A. Cadoo ◽  
Diana L. Mandelker ◽  
Semanti Mukherjee ◽  
Carolyn Stewart ◽  
Deborah DeLair ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Next Generation Sequencing ◽  
Lynch Syndrome ◽  
Microsatellite Instability ◽  
Mismatch Repair ◽  
Cancer Predisposition ◽  
Next Generation ◽  
Germline Variants ◽  
Predisposition Genes ◽  
Generation Sequencing

PURPOSE Mutations in DNA mismatch repair genes and PTEN, diagnostic of Lynch and Cowden syndromes, respectively, represent the only established inherited predisposition genes in endometrial cancer to date. The prevalence of other cancer predisposition genes remains unclear. We determined the prevalence of pathogenic germline variants in unselected patients with endometrial cancer scheduled for surgical consultation. PATIENTS AND METHODS Patients prospectively consented (April 2016 to May 2017) to an institutional review board–approved protocol of tumor-normal sequencing via a custom next-generation sequencing panel—the Memorial Sloan Kettering–Integrated Mutation Profiling of Actionable Cancer Targets—that yielded germline results for more than 75 cancer predisposition genes. Tumors were assessed for microsatellite instability. Per institutional standards, all tumors underwent Lynch syndrome screening via immunohistochemistry (IHC) for mismatch repair proteins. RESULTS Of 156 patients who consented to germline genetic testing, 118 (76%) had stage I disease. In 104 patients (67%), tumors were endometrioid, and 60 (58%) of those tumors were grade 1. Twenty-four pathogenic germline variants were identified in 22 patients (14%): seven (4.5%) had highly penetrant cancer syndromes and 15 (9.6%) had variants in low-penetrance, moderate-penetrance, or recessive genes. Of these, five (21%) were in Lynch syndrome genes (two MSH6, two PMS2, and one MLH1). All five tumors had concordant IHC staining; two (40%) were definitively microsatellite instability–high by next-generation sequencing. One patient had a known BRCA1 mutation, and one had an SMARCA4 deletion. The remaining 17 variants (71%) were incremental findings in low- and moderate-penetrance variants or genes associated with recessive disease. CONCLUSION In unselected patients with predominantly low-risk, early-stage endometrial cancer, germline multigene panel testing identified cancer predisposition gene variants in 14%. This finding may have implications for future cancer screening and risk-reduction recommendations. Universal IHC screening for Lynch syndrome successfully identifies the majority (71%) of high-penetrance germline mutations.

scholarly journals 348 A phase 2 umbrella study of retifanlimab (INCMGA00012) alone or in combination with other therapies in patients with advanced or metastatic endometrial cancer (POD1UM-204, GOG 3038, ENGOT-en12/NOGGO)

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A374-A374
Author(s):  
Brian Slomovitz ◽  
Bradley Monk ◽  
Katherine Moxley ◽  
Nadeem Ghali ◽  
Justyna Fronczek Sokol ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Endometrial Cancer ◽  
Microsatellite Instability ◽  
Mismatch Repair ◽  
Checkpoint Inhibitors ◽  
Clinical Activity ◽  
Phase 2 ◽  
Monotherapy Group ◽  
Open Label ◽  
Group A

BackgroundManagement of advanced endometrial cancer after failure with platinum therapy remains a challenge. Tumors characterized by DNA repair abnormalities are associated with high numbers of neoantigens; immunotherapy is promising in this setting as demonstrated in studies with checkpoint inhibitors (CPI). 1–6 Overcoming emerging resistance to CPI through novel combinations is a focus of research. Retifanlimab is an investigational humanized immunoglobulin G4 monoclonal antibody against programmed cell death 1 (PD 1). In POD1UM-101, retifanlimab monotherapy demonstrated acceptable tolerability and durable clinical benefit in multiple advanced tumor types, including pretreated endometrial cancer.7 POD1UM-204 is designed to further investigate efficacy and safety of retifanlimab alone or in combination with other immunotherapy or targeted agents in patients with advanced/metastatic endometrial cancer.MethodsPOD1UM-204 is a phase 2, multicenter, nonrandomized, open-label, umbrella study in women =18 years of age, with histologically confirmed diagnosis of advanced/metastatic endometrial cancer that has progressed on or after platinum-based chemotherapy. Patients must have an ECOG performance status =1, at least 1 measurable tumor lesion by Response Evaluation Criteria in Solid Tumors v1.1, and provide tumor tissue at baseline.Approximately 220 patients will be enrolled into 4 treatment groups: Group A–patients with MSI-H (microsatellite instability high) endometrial cancer and no prior CPI therapy (up to 100 patients) receiving retifanlimab monotherapy; Group B–patients with dMMR (deficient DNA mismatch repair) or POLE (DNA polymerase epsilon) endometrial cancer and no prior CPI therapy (up to 40 patients) receiving retifanlimab monotherapy; Group C–patients with unselected endometrial cancer and regardless of prior CPI treatment (up to 40 patients) receiving retifanlimab plus epacadostat (indoleamine 2,3-dioxygenase inhibitor); and Group D–patients with endometrial cancer and activating fibroblast growth factor receptor (FGFR1, 2 or 3) mutations or alterations outside of the kinase domain and regardless of prior CPI treatment (up to 40 patients) receiving retifanlimab plus pemigatinib (FGFR1, 2, 3 inhibitor) (figure 1). Patients can receive up to 26 treatment cycles if they continue to derive benefit and have not met criteria for withdrawal.The primary study objective is evaluating retifanlimab monotherapy antitumor activity (objective response rate [ORR] determined by independent central review [ICR]) in Group A. Secondary study objectives include assessing additional efficacy measures (duration of response, disease control rate and progression-free survival by ICR, and overall survival) in Group A; determining clinical activity (ORR by the investigator) in Groups B, C and D; and evaluating safety and tolerability of retifanlimab.Abstract 348 Figure 1POD1UM-204 study designResultsN/AConclusionsN/AAcknowledgementsThis study is sponsored by Incyte Corporation (Wilmington, DE).Trial RegistrationClinicalTrials. gov Identifier: NCT04463771; EudraCT 2020-000496-20Ethics ApprovalThe study was approved by institutional review boards or independent ethics committees of participating institutions.ConsentN/AReferencesMittica G, Ghisoni E, Giannone G, et al. Checkpoint inhibitors in endometrial cancer: preclinical rationale and clinical activity. Oncotarget 2017;8:90532–544.Di Tucci C, Capone C, Galati G, et al. Immunotherapy in endometrial cancer: new scenarios on the horizon. J Gynecol Oncol 2019;30:e46.Brooks R, Fleming G, Lastra R, et al. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019;69:258–79.Makker V, Rasco D, Vogelzang N, et al. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer: an interim analysis of a multicentre, open-label, single-arm, phase 2 trial. Lancet Oncol 2019;20:711–8.Marabelle A, Le D, Ascierto P, et al. Efficacy of Pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair–deficient cancer: results from the phase II KEYNOTE-158 study. J Clin Oncol 2020;38:1–10.Oaknin, A, Duska L, Sullivan R, et al. Preliminary safety, efficacy, and pharmacokinetic/pharmacodynamic characterization from GARNET, a phase I/II clinical trial of the anti–PD-1 monoclonal antibody, TSR-042, in patients with recurrent or advanced MSI-h and MSS endometrial cancer. Gynecol Oncol 2019;154(suppl 1):17 [Abstract 33].Mehnert JM, Joshua AM, Lakhani N, et al. First-in-human phase 1 study of INCMGA00012 in patients with advanced solid tumors: interim results of the cohort expansion phase. J Immunother Cancer 2018;6(suppl 1):115 [Abstract P669].

scholarly journals Mismatch Repair Proteins (MLH1, MSH2, MSH6, and PMS2) Immunohistochemical Expression and Microsatellite Instability in Endometrial Carcinoma

2020 ◽  
Vol 8 (A) ◽  
pp. 306-310
Author(s):  
Nour El Hoda S. Ismael ◽  
Hala M. Naguib ◽  
Suzan Mohamed Talaat ◽  
Rasha F. Bakry
Keyword(s):  
Endometrial Cancer ◽  
Microsatellite Instability ◽  
Endometrial Carcinoma ◽  
Mismatch Repair ◽  
Tumor Grade ◽  
Clinicopathological Parameters ◽  
Small Subset ◽  
Immunohistochemical Expression ◽  
Mismatch Repair Proteins ◽  
Mmr Proteins

BACKGROUND: Endometrial cancer (EC) is the fourth most common female cancer worldwide constituting 7% of cancer in women. It is a disease of older, postmenopausal women. The most of these patients have an identifiable source of excess estrogen, while in a small subset the pathogenesis is related to mismatch repair abnormality and lynch syndrome (LC). Mismatch repair behave as tumor suppressors and the most clinically relevant include MLH1, MSH2, MSH6, and PMS2. mutations in mismatch repair (MMR) results in a strong mutator phenotype known as microsatellite instability, which is a hallmark of LC-associated cancers. AIM: The aim of the study was to study microsatellite instability in endometrial cancer using the immunohistochemical expression of mismatch repair proteins (MLH1, MSH2, MSH6 and PMS2). MATERIAL AND METHODS: Sixty EC cases were studied using MLH-1, MSH-2, MSH-6, and PMS-2 immunohistochemistry and their expression was correlated with different clinicopathologic parameters. RESULTS: A statistically significant relationship exists between MMR immunohistochemistry (IHC) proteins and tumor grade. Intact MMR proteins profile was associated with the lower tumor grade (31.3% were Grade 1 and 46.9% were Grade 2). Combined loss of MLH1/PMS2, combined loss of MSH2/MSH6, and isolated loss of PMS2 were also associated with the lower tumor grade while isolated loss of MSH6 was associated with the high tumor grade. However, no statistically significant correlation was found between MMR IHC proteins expression and the age of patients; tumor histopathological types, or FIGO stage. CONCLUSION: A statistically significant correlation between the tumor grade of EC cases and the MMR IHC proteins was found. Further studies are recommended to assess correlation between MMR proteins defect and different clinicopathological parameters of endometrial carcinoma.

scholarly journals THE STUDY OF MISMATCH REPAIR IN ENDOMETRIAL CANCER PATIENTS WITH A FAMILY HISTORY OF CANCER

2015 ◽  
Vol 37 (4) ◽  
pp. 272-276 ◽  
Author(s):  
L G Buchynska ◽  
O Brieieva ◽  
K N Nekrasov ◽  
S V Nespryadko
Keyword(s):  
Endometrial Cancer ◽  
Family History ◽  
Microsatellite Instability ◽  
Mismatch Repair ◽  
Molecular Mechanisms ◽  
Tissue Samples ◽  
Family History Of Cancer ◽  
The Family ◽  
History Of ◽  
History Of Cancer

Aim: To assess the expression of mismatch repair (MMR) proteins MSH2 and MLH1 and carry out microsatellite analysis in patients with endometrial cancer (EC) with regard to the family history of cancer. Materials and Methods: Morphological and immunohistochemical study was performed on tumor tissue samples of 49 EC patients. Microsatellite instability was determined using PCR with primers which flank microsatellite region BAT-26. Results: A tendency to a decreased expression of both MSH2 and MLH1 markers in a group of EC patients with a family history of cancer as compared with a group without aggregation of cancer in family history was observed (labeling index — LI — was 36.1 ± 8.1% and LI 20.7 ± 9.1% versus LI 48.0 ± 5.8% and 33.8 ± 5.8%, respectively). It was determined that the number of EC patients with tumors deficient by expression of MMR markers was reliably higher in a group of patients with a family history of cancer than in a group of patients without aggregation of cancer in fami ly history (р < 0.05). It was shown that in a group of EC patients with a family history of cancer, MMR-proficient tumors were detected in 38.5% of cases. Microsatellite instability was determined in 10.7% of EC patients including one patient with aggregation of Lynch-associated tumors in family history. Conclusion: Family history of cancer of EC patients is associated with malfunctioning of the MMR system as well as may be related to alternative molecular mechanisms.

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