Predictive Value of DNA Mismatch Repair System in Colorectal Cancers

MSI-H Colorectal Cancer Clinical Trial

— DNAMMR  

Official title:

Assessment of the DNA Mismatch Repair System is Crucial in Colorectal Cancers Necessitating Adjuvant Treatment: a Propensity Score-matched and Win Ratio Analysis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05871567
• Other study ID #: Università Vanvitelli Napoli
• Status: Completed
• Start date: January 1, 2014
• Est. completion date: March 31, 2023

Study information

• Verified date: May 2023
• Source: University of Campania "Luigi Vanvitelli"
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

• Microsatellite instable (MSI) tumors represent almost the 15% of all sporadic colorectal cancers (CRCs).

• Literature data show that this unique tumor population appears to be poorly responsive to conventional chemotherapy and conversely reveals excellent results to immunotherapy.

• Our data, as demonstrated by propensity score-matched and win ratio analysis, show that there are no substantial differences between MSI and MSS tumors in early CRC stages treated with surgery alone.

• On the contrary, stable tumors (MSS) did much better than MSI tumors in advanced CRC stages undergoing conventional adjuvant treatment.

• Determination of status of DNA mismatch repair system is crucial in high-risk CRCs to optimize treatment.

Description:

Colorectal cancers (CRCs) with deficient DNA mismatch repair (MMR) system (so called dMMR or MSI tumors) represent a no-negligible part of sporadic CRCs. Prognostic value of this unique cell population remains controversial, but undoubtedly these tumors are characterized by poor response to conventional chemotherapy, an high tumor mutational burden resulting in a brisk immuno response, and, as recently observed, excellent results to the immunotherapy. The aim of this study was to evaluate, by using sophisticated statistical analyses, the predictive value of MSI status and its optimal treatment.

A series of 403 consecutive CRC patients treated by the same oncological team from 2014 to 2021 entered the study. No patients underwent immunotherapy. Immunohistochemistry, integrated by polymerase chain reaction if appropriate, was used to categorize specimens in microsatellite stable (MSS) and instable (MSI) tumors. The win ratio (WR) approach was utilized to compare composite outcomes of MSS and MSI tumors while controlling for radical versus no radical resection, propensity score-matched analysis, and reversing primary endpoint.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 403
• Est. completion date: March 31, 2023
• Est. primary completion date: December 31, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 86 Years

Eligibility

Inclusion Criteria:

• all consecutive CRC patients observed from January 2014 to December 2021

Exclusion Criteria:

• Patients with suspected or confirmed Lynch's syndrome (12 patients) and rectal cancers (98 patients) undergoing neoadjuvant treatment

Related Conditions & MeSH terms

• Colorectal Neoplasms
• MSI-H Colorectal Cancer

Intervention

Procedure:
• colorectal resection
potential resective surgery

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
University of Campania "Luigi Vanvitelli"

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	survival rate	overall survival	"From date of surgical operation until the date of death from any cause assessed up to 60 months"
Secondary	recurrence rate	disease-free survival	"From date of surgical operation until the date of documented tumor recurrence assessed up to 60 months"