Synthetic data only. Educational use only. Synthetic data, demonstration only. Not a medical device. Not for unsupervised clinical decision-making.
Tumor-agnostic TMB-high + MSI-H
The starting input
A Tempus xT sample. Mismatch-repair-deficient colorectal adenocarcinoma, but the same biology drives a tumor-agnostic recommendation across many cancers. Sample at data/sample_reports/tempus/tempus_xt_sample.pdf. Try the Tempus render on the vendor sample showcase.
What the parser extracts
- Variants: MLH1 splice-region, MSH2 frameshift (detected in the tumor specimen; the Tempus xT assay is tumor-only, so germline versus somatic origin is not established by this report)
- Biomarkers: TMB 21 mut/Mb (high), MSI-H, MMR-deficient
- FDA CDx flag: pembrolizumab tumor-agnostic indication
Tempus formats biomarkers as a top-of-report banner. The parser anchors on that and emits structured biomarker entries with page and char-offset provenance.
What the evidence join adds
- openFDA: pembrolizumab tumor-agnostic indication for MSI-H or dMMR solid tumors after progression on standard therapy
- CIViC + ClinVar: MLH1 / MSH2 pathogenic Lynch syndrome alleles
- ClinicalTrials.gov: 100+ MSI-H trials, including basket designs
- AMP/ASCO/CAP tier: I-A
Live at /lookup.
What the CDS surface produces
The tumor-agnostic predicate is a deterministic OR over the biomarker set. Engine 2 surfaces the pembrolizumab option, a Lynch-syndrome pointer that recommends germline MMR testing and genetic counseling (because both variants sit in MMR genes and a tumor-only report cannot confirm germline origin on its own), and the matching trial list. Sticky educational-use banner. No LLM in the rendering path.
Live at /recommendations.
Why this case matters for buyers
TMB and MSI are biomarkers, not variants. Vendors disagree about how to compute and report them. Different cutoffs, different denominators, different tables. UNMIRI doesn't recompute them. It normalizes the vendor's reported value with provenance and marks the vendor's methodology block. The CDS layer reads the normalized biomarker, not a vendor string. See the side-by-side compare view for that.
Related references
Variant cheat sheet
MSI-H / dMMR pan-tumor
Pembrolizumab tumor-agnostic, Lynch syndrome workup.
Trial-by-gene
Active MSI-H pan-tumor trials
Neoadjuvant immunotherapy, post-ICI resistance.
Trial-by-gene
Active TMB-H pan-tumor trials
Tumor-agnostic pembrolizumab and novel ICI combinations.
Product
CDS API
The Engine 2 path: tumor-agnostic predicate routing.
Live demo
Try the CDS card live
Tempus TMB + MSI fixture; pembrolizumab tumor-agnostic surface.
Live demo
Vendor sample showcase
Watch the Tempus fixture parse end-to-end.