The identification of new, effective drugs is a pressing need in
colorectal cancer (CRC) rescue
therapy. Data examining O (6)-methylguanine-DNA-methyl
transferase (MGMT) and its predictive role in
temozolomide (TMZ) treatment in CRC are scarce. In this study, the effect of MGMT status on the cytotoxic sensitivity caused by TMZ was analyzed using cytology proliferation assays in
colon cancer cell lines. MGMT
protein expression was assessed with immunohistochemistry in 385 patients. Concordance between primary and metastatic sites and the role of MGMT status on survival were statistically analyzed. TMZ sensitivity was significantly affected by the level of MGMT
protein expression. Of 385 cases, 13 (3.4 %) demonstrated loss of MGMT expression. However, low MGMT expression levels were significantly more common in signet ring cell
carcinomas (p = 0.011). In 111 of 385 cases, the overall concordance of MGMT status between primary
tumor and metastatic sites was 66.67 % (κ = 0.271, p < 0.001). The median progression-free survival was significantly different between groups with low or high MGMT expression for the
irinotecan-based regimen (p = 0.025), but MGMT
protein expression was not observed to be a prognostic factor. In conclusion, MGMT was an important in vitro predictor of TMZ activity in CRC. The rate of MGMT
protein loss was low in metastatic CRC patients from China, and MGMT might be more commonly lost in
signet ring cell carcinoma. The MGMT status at primary and metastatic sites was consistent, but the power of concordance was poor. Further study into these topics is warranted.