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MSI-H/dMMR Cancer

A headshot of a middle-aged Pasifika woman with orange flowers decorating her hair. She is smiling softly and gazing off into the distance.

If you or someone you know has been diagnosed with cancer which is shown by a laboratory test to be MSI-H or dMMR, you may be trying to learn as much as possible about your cancer and its treatments. MSI-H is short for MicroSatellite Instability-High. dMMR is short for deficient MisMatch Repair. Read on to find out more.

The information on this website should be discussed with your healthcare professional and does not replace their advice.

What is MSI-H/dMMR cancer?

MSI-H/dMMR are biomarkers that can be found in many different types of cancer. However, they are most often found in cancers of the colon, rectum, endometrium, and stomach.

Biomarkers can be detected in blood, other body fluids or tissues.

An icon representing DNA

What causes MSI-H/dMMR?

Normal cells have a system that detects and repairs mistakes that happen when your DNA is copied. It’s called the DNA mismatch repair (MMR) system.

Sometimes the system stops working properly. MSI-H/dMMR can occur when a cell is unable to repair mistakes. When this happens, errors in the DNA mount up and may cause cancer.

An icon depicting a laboratory microscope.

Who should be tested for MSI-H/dMMR?

Everyone’s cancer is different. To help develop a treatment plan that’s right for you, your doctor may order laboratory tests. These tests can assess your cancer for different biomarkers, including MSI-H or dMMR.

Some biomarkers are used to help predict if you are likely to respond to certain treatments. The Ministry of Health recommends that all newly diagnosed patients with colorectal cancer in New Zealand are tested for dMMR.

As with all cancers, treatment options vary based on a variety of factors. Some of the things that are taken into consideration include the type and stage of the cancer as well as your general health and personal preferences.

Deciding which treatment is most appropriate is a shared process between you and your healthcare team. One treatment option that may be considered is immunotherapy. Immunotherapy works by helping your immune system fight your cancer.

Treatment with KEYTRUDA® (pembrolizumab)

KEYTRUDA is an immunotherapy that may be used to treat certain patients with MSI-H/dMMR cancer:

  • KEYTRUDA may be used as your first treatment when your colorectal cancer has spread or cannot be removed by surgery, and has been shown by a laboratory test to be MSI-H or dMMR. KEYTRUDA is funded for patients who meet specific criteria.
  • KEYTRUDA may be used in adults and children when your colorectal cancer has spread or cannot be removed by surgery, and has been shown by a laboratory test to be MSI-H or dMMR, and has progressed after treatment with certain chemotherapy. KEYTRUDA is funded for patients who meet specific criteria.
  • KEYTRUDA may be used in adults and children to treat advanced MSI-H or dMMR cancer of any part of the body which has been shown by a laboratory test to be MSI-H or dMMR, and who have received other treatment which has not worked or is no longer working, and there are no other satisfactory treatment options. However, KEYTRUDA is not funded for the treatment of these patients, which means you will need to pay for the full cost of the medicine and its administration.

It is not known if KEYTRUDA is safe and effective in children with MSI-H cancers of the brain or spinal cord (central nervous system cancers).

To determine if KEYTRUDA is a suitable option for you, please consult your doctor.

References:

National Cancer Institute. NCI Dictionary of Cancer Terms. Microsatellite instability-high cancer. 
Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/msi-h-cancer
Accessed on 20/03/2025 

National Cancer Institute. NCI Dictionary of Cancer Terms. Mismatch repair deficiency. 
Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/mismatch-repair-deficiency
Accessed on 20/03/2025 

National Cancer Institute. NCI Dictionary of Cancer Terms. Biomarker. 
Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/biomarker 
Accessed on 20/03/2025 

Cancer Council Australia. 2025. Understanding Immunotherapy. A guide for people affected by cancer. 
Available at: https://www.cancer.org.au/assets/pdf/understanding-immunotherapy-fact-sheet
Accessed on 22/04/2025   

Ministry of Health. 2018. Molecular Testing of Colorectal Cancers in New Zealand: Minimum standards for molecular testing of newly diagnosed colorectal cancers. Wellington: Ministry of Health.

Te Whatu Ora – Health New Zealand. 2023. Clinical Practice Guidelines for Bowel Screening in New Zealand. Wellington: Te Whatu Ora – Health New Zealand. 

American Cancer Society. Treatment Types.
Available at: https://www.cancer.org/cancer/managing-cancer/treatment-types.html
Accessed on 26/06/2024

American Cancer Society. Understanding Your Options for Cancer Treatment.
Available at: https://www.cancer.org/cancer/managing-cancer/making-treatment-decisions/making-decisions.html
Accessed on 20/10/2025

National Cancer Institute. NCI Dictionary of Cancer Terms. Immunotherapy.
Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunotherapy
Accessed on 17/06/2019

KEYTRUDA Data Sheet

KEYTRUDA Consumer Medicine Information

PHARMAC. The Pharmaceutical Schedule.
Available at: https://www.pharmac.govt.nz/pharmaceutical-schedule
Accessed on 17/07/2025

NZ-KEY-00881v2.0. TAPS DA 2515PC TAPS NP24027. Last updated May 2026.