Patient # 1 harbored an ultra-mutated (Mutation Load/MB = 117.3, total mutations = 4660) tumor driven by mutation in the exonuclease domain of the DNA polymerase ε gene. Patient # 2 harbored a hyper-mutated tumor (Mutation Load/MB = 33.5, total mutations = 1037) due to a germinal MSH6 gene mutation. Both patients demonstrated a remarkable clinical response to the anti-PD1 immune check-point inhibitor nivolumab.