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MSI-high / dMMR mCRC — treatment-defining biomarker. KEYNOTE-177 established pembrolizuma...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-CRC-MSI-H-ACTIONABILITY
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-CRC
SourcesSRC-ESMO-COLON-2024 SRC-NCCN-COLON-2025

Red Flag Origin

DefinitionMSI-high / dMMR mCRC — treatment-defining biomarker. KEYNOTE-177 established pembrolizumab 1L over FOLFOX+bev (PFS 16.5 vs 8.2 mo). This RF intensifies toward the immunotherapy track and overrides the default RAS/BRAF-driven chemo algorithm.
Clinical directionintensify
Categoryhigh-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "msi_status",
      "value": "MSI-H"
    },
    {
      "finding": "dmmr_status",
      "value": "deficient"
    }
  ],
  "type": "biomarker"
}

Notes

MSI-H/dMMR ~5% of metastatic CRC, ~15% of stage II-III. Adjuvant setting — ICI not yet standard outside trials (NICHE/NICHE-2 promising for neoadjuvant ICI in non-metastatic dMMR colon — emerging paradigm). Lynch-syndrome-driven dMMR cases warrant germline testing + family counseling.

Used By

Algorithms

Indications

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