Question about MSI

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dauofcamom
Posts: 34
Joined: Sun Apr 22, 2018 7:11 pm

Question about MSI

Postby dauofcamom » Fri May 18, 2018 7:29 pm

My mom is having genetic testing on her tumor. She is MSI. I’m confused by some things I’ve read. Would/should her treatment change from Xelox regime to something different?

Forgive me for not remembering but there were 4 things that are indicators (not sure if that’s the right terminology). She has defective MLH1 and PMS2 but her MSH2 and MSH6 were normal.

What should I know?

Cecum tumor
G3
T4bN1aM0
Margins clear.
Long Distance Caregiver to 75 year old Mom
3/2018 - colonoscopy, DX malignant cecum mass
4/2018 - right hemi
Stage IIIC - T4bN1aM0
MSI High
5/2018 - Xelox Regime
10/2018 - peri Mets discovered
10/2018 - Start Keytruda every 3 weeks
12/2018 - scan all clear

User avatar
O Stoma Mia
Posts: 1602
Joined: Sat Jun 22, 2013 6:29 am

Re: Question about MSI

Postby O Stoma Mia » Sat May 19, 2018 12:41 am

Your mom is Stage III-C colon cancer and is currently undergoing XELOX(CAPEOX) adjuvant therapy.

Information on the use of MSI testing as well as information on the selection of appropriate adjuvant therapies for her stage can be found in the NCCN Guideline for Colon Cancer:

https://www.nccn.org/patients/guidelines/colon/index.html

The section on MMR and MSI testing starts here:
https://www.nccn.org/patients/guidelines/colon/index.html#22

Adjuvant therapy for Stage III is summarized here: The preferred regimens for Stage III are FOLFOX, or CAPEOX(XELOX), so your mom is on one of the preferred regimens
https://www.nccn.org/patients/guidelines/colon/index.html#44

NHMike
Posts: 2508
Joined: Fri Jul 21, 2017 3:43 am

Re: Question about MSI

Postby NHMike » Sat May 19, 2018 11:59 am

dauofcamom wrote:My mom is having genetic testing on her tumor. She is MSI. I’m confused by some things I’ve read. Would/should her treatment change from Xelox regime to something different?

Forgive me for not remembering but there were 4 things that are indicators (not sure if that’s the right terminology). She has defective MLH1 and PMS2 but her MSH2 and MSH6 were normal.

What should I know?

Cecum tumor
G3
T4bN1aM0
Margins clear.


They want to know the Gene Mutations of the tumor. It can be useful in some cases to determine that she has an aggressive mutation. In some cases, it may be useful for treatment. There aren't a lot of options for CRC at this point, besides the usual treatments, but I expect that to change a lot in the next year or two.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

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henry123
Posts: 214
Joined: Sun Oct 08, 2017 3:25 am

Re: Question about MSI

Postby henry123 » Mon May 21, 2018 10:06 am

Hello,
Please read my history.
Study and consider immunotherapies such as opdivo, keytruda as an option. It seems to be working for msi-high cases only so far.
46yo M msi-high Lynch +ve
5/16 lap AR 14/21 L nodes +ve
T4N2M1
7/16 Capox 9 cyc
9/16 cea 2
1/17 550
PET CT mets in lung & peri
iri+ avast fail
3/17 10577
4/17 regro fail
5/17 cea 28800
5/17 CT inc in size of mes nodes ,onset of multi nodules in liver
6/17 Opdivo start
7/17 26754
8/17 5623
9/17 497
10/17 52
11/17 12
CT all clear exc a nodule in Lung. liver norm
1/18 3.6
4/18 2
Aspirin start
6/18 1.5 CT clear
12/18 1.1 NED
6/19 .9 CT clear
1/20 NED Opdivo stop


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