{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:07:54Z","timestamp":1788944874158,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Mismatch repair (MMR) status has moved from hereditary-cancer screening to a central predictive biomarker for immunotherapy in endometrial cancer. The marked difference in treatment benefit between MMR-deficient\/microsatellite instability-high (dMMR\/MSI-H) and MMR-proficient\/microsatellite-stable (pMMR\/MSS) tumors creates an economic rationale for companion testing, but the value of testing depends on assay accuracy, treatment price, duration, survival extrapolation, and local willingness-to-pay thresholds. This Mini Review examines the clinical and economic value of MMR-guided immunotherapy in advanced and recurrent endometrial cancer. A targeted literature search of PubMed\/MEDLINE, Embase, Web of Science, and the Cochrane Library from database inception through 31 July 2026. We summarize practical testing pathways based on four-protein immunohistochemistry, reflex mutL homolog 1 (MLH1) promoter methylation, MSI assays, and selective next-generation sequencing; review MMR-stratified evidence from major immunotherapy trials; and compare published cost-effectiveness analyses of pembrolizumab, dostarlimab, atezolizumab, durvalumab-based regimens, and pembrolizumab plus lenvatinib. Across studies, dMMR\/MSI-H disease generally generates the largest quality-adjusted survival gains and the most favorable incremental cost-effectiveness ratios, whereas the economic case in pMMR\/MSS disease is more sensitive to drug pricing and modeling assumptions. Overall, MMR testing can function as an allocation technology that prioritizes high-value treatment, while future work should harmonize testing, manage discordant results, refine biomarkers for pMMR tumors, and incorporate long-term survival, quality of life, equity, and value of information into economic models.<\/jats:p>","DOI":"10.3389\/fmed.2026.1951624","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:30:43Z","timestamp":1788942643000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The economic value of mismatch repair\u2013guided immunotherapy in endometrial cancer: companion testing and patient selection"],"prefix":"10.3389","volume":"13","author":[{"given":"Sihan","family":"Jing","sequence":"first","affiliation":[{"name":"School of Maritime Economics and Management, Dalian Maritime University","place":["Dalian, 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