In a breakthrough trial of 12 rectal cancer patients who took the same drug for six months, cancer ‘disappeared’ in all of them. The patients underwent a battery of medical examinations — physical exam, endoscopy, bioscopy, PET scans and MRI scans — but none of the reports showed signs of the tumor at a median follow-up of one year.
Published in the New England Journal of Medicinethe paper said the small but compelling study “two” therapy progress together” of non-operative management. The compelling results were presented at the ASCO 2022 Annual Meeting by Andrea Cercek, MD, chief of colorectal cancer and co-director of the Center for Young-Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center (Abstract LBA5).
Well deserved ovation for Dr. @AndreaCercek and the GI Onc team at @MSKCancerCenter † Yes, you read that right: 100% cCCR in pts with MSI-H/dMMR LA Rectal cancer with IO. This means no CT, RT, or surgery may be required! This is a game changer for our patients! pic.twitter.com/oLPD36TsfW
— Alan Burguete-Torres MD (@dralanburguete) June 5, 2022
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Rectal cancer affects the lower part of the colon. It is traditionally treated with chemotherapy, radiation, and surgery.
In the study, immunotherapy with the programmed death 1 (PD-1) inhibitor dostarlimab was followed by nonoperative care in patients with mismatch repair-deficient stage II or III rectal cancer. All 12 patients received dostarlimab for six months with careful monitoring of clinical response by magnetic resonance imaging, F-fluorodeoxyglucose-positron emission tomography, and endoscopy.
It’s not an experimental drug, it falls under the immunotherapy paradigm, Dr. Mandeep Singh Malhotra, Department of Oncology, CK Birla Hospital, Delhi.
“In scientific terms, we call them checkpoint inhibitors. Such types of drugs are used in lung, breast and other cancer subtypes. The drug removes or reveals the controls that inhibit our immune cell, ie T cells, to kill or turn off the cancer cell,” he described.
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The paper analyzed patients who did not have a complete response and who would receive subsequent standard radiation therapy and chemotherapy; however, all 12 patients had complete tumor resolution with dostarlimab. At a median follow-up of 1 year, none of the 12 patients had required any other treatment and none of them had had cancer regrowth. None of the patients had Grade 3 or greater adverse reactions.
— Memorial Sloan Kettering Cancer Center (@MSKCancerCenter) June 5, 2022
However, given that the chance of regrowth increases by 20-30 percent in nonoperative patients, the study authors note that “very little is known about the length of time it takes to find out whether a clinically complete response to dostarlimab is equal.” is on healing.”
The study’s author, Hanna K Sanoff, also added that to provide more information about patients who may benefit from immunotherapy, follow-up studies should look for “heterogeneity in age, coexisting conditions, and tumor mass.”
Why is this study important for cancer research and treatment?
The result of this report is very encouraging, but we can’t read too much into it until a larger trial is done, Dr. Ashok Kumar Vaid, Chairman, Medical and Haemato Oncology, Cancer Institute, Medanta Hospital Gurugram, indianexpress.com† “The findings will only be validated once a larger study has been carried out. For now, however, the results in these cases are very good and promising. The drug is a type of immunotherapy – known as an immune checkpoint inhibitor – it works through the immune system from the body. We don’t know if it will work for other cancers other than rectal cancer because no tests and trials have been done,” he explained.
dr. Malhotra emphasized that the study shows promise and said it is important to understand that it was used in patients whose colorectal cancer had a high tumor mutation burden and that the cancer used these checkpoints to determine the immune system† “It’s not like all cancers and all colorectal cancers will use these checkpoints to evade, survive or grow the immune system. A cancer uses multiple pathways and methodologies to survive and grow, he added that a large trial would be more suitable for a greater understanding.
It is not known whether these patients with clinical complete response also had a pathological complete remission, Dr. Suhas Aagre, oncologist and hemato-oncologist, Asian Cancer Institute.
The human microbiome is a new addition to cancer treatment that tends to suppress an overactive immune system in inflammatory diseases and amplify the response of a suppressed immune system in cancers, said Dr. agre.
According to Dr. Anil Thakwani, senior consultant oncologist, Fortis Noida Vejovis Superspeciality Clinic, the trial may not work for all types of cancer. “It seems to be effective only in the case of rectal cancers, which have a defective repair gene mismatch, and in those who are resistant to chemotherapy. The pitfall of the process is that it is very short – six months. We have to take a while.” wait and do a follow-up on these patients. We shouldn’t be too happy,” he said, stressing that different types of rectal cancer patients should be compared in a large study in the future.
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