MSI-H gástrico/GEJ adenocarcinoma (~5-10% dos casos) está associado com melhora da resposta t...
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| ID | BMA-MSI-STATUS-GASTRIC |
|---|---|
| Tipo | Relevância terapêutica |
| Estado | reviewed 2026-05-07 | actionability review required |
| Doenças | DIS-GASTRIC |
| Fontes | SRC-ESMO-GASTRIC-2024 SRC-NCCN-GASTRIC-2025 |
Fatos de ação
| Biomarcador | BIO-MSI-STATUS |
|---|---|
| Variante | MSI-H |
| Doença | DIS-GASTRIC |
| Nível ESCAT | IIA |
| Combinações recomendadas | pembrolizumab + fluoropyrimidine + platinum (MSI-H gastric per SRC-NCCN-GASTRIC-2025, noting PDL1 CPS ≥5 threshold also applies per IND-GASTRIC) |
| Resumo das provas | MSI-H gastric/GEJ adenocarcinoma (~5-10% of cases) is associated with improved response to ICI. Pembrolizumab is FDA-approved tumor-agnostically for MSI-H/dMMR solid tumors (KEYNOTE-158, 2017). MSI-H status was a pre-specified subgroup in KEYNOTE-859 (pembro + chemo vs chemo) — benefit was demonstrated across CPS subgroups. Per NCCN Gastric 2025 and ESMO Gastric 2024, MSI-H testing (PCR or NGS) is recommended alongside PD-L1 CPS and HER2 at initial diagnosis of metastatic gastric/GEJ adenocarcinoma. ESCAT tier IIA (pre-specified subgroup benefit; FDA approval via tumor-agnostic pathway, not GI-specific indication). Indication selection enforced by algorithm layer; this BMA surfaces context. |
Notas
ESCAT IIA (not IA) because the gastric-specific MSI-H evidence is primarily from tumor-agnostic KEYNOTE-158 and a subgroup of KEYNOTE-859 rather than a dedicated MSI-H gastric trial with OS primary endpoint. Variant_qualifier "MSI-H" ensures MSS/pMMR patients do not match this cell.
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