Twenty of the 49 patients received induction chemotherapy with 5FU and oxaliplatin...28% (n = 5) of patients demonstrated progressive disease while on therapy. The majority of these cases, 82% (41/50) harbored germline mutations in the MMR genes and the observed prevalence of germline MSH2 and MSH6 mutations was significantly higher in the rectal (n = 41)...Patients with MMR-D rectal tumors appear to have a high chance of disease progression on induction chemotherapy.