Best supportive care in a young patient with locally advanced MSI-high colon cancer?

Molecular diagnostics are increasingly important to guide treatment decisions in oncologic patients. For instance, the presence of high-grade microsatellite-instability (MSI-high) is considered to be one of the major positive predictors of therapy response to immune-checkpoint inhibitors in patients with solid tumors. Based on impressive results from several immune-oncology trials, the American Food and Drug Administration (FDA) granted approval to immunotherapy in any previously treated, MSI-high solid cancer in 2017. Here, we report the clinical case of a young patient with MSI-high colorectal cancer. The case illustrates, that insurance companies in Germany are still reluctant to cover the cost of immunotherapy in this specific patient subgroup, which, in our opinion, results in an ethically problematic therapeutic dilemma.