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Rectal cancer: treatment with dostarlimab

2022-06-09T17:48:24.921Z


Twelve cancer patients treated, twelve times the cancer stopped, without surgery or radiation: the active ingredient dostarlimab causes a stir. But there are still too many question marks to declare a sensation.


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Cancer screening by a gastroenterologist: Positive study result cannot be transferred to other types of cancer

Photo: ola20/Getty Images/iStockphoto

First of all: The study is too small to speak of a breakthrough, further data are not only important, but absolutely necessary.

But the result is so striking that it is worth mentioning.

In a so-called phase II study, patients with rectal cancer that had not yet spread received the active ingredient dostarlimab.

The study provided for radiotherapy, chemotherapy and surgery to follow, depending on the course of the disease.

But for all twelve of those affected, who have been in treatment for at least six months, all this was unnecessary.

So far, they have been spared very stressful therapies.

They are in remission, the cancer is no longer detectable in them.

However, it is too early to speak of a cure, the time span is too short for that.

A team led by Andrea Cercek from the Memorial Sloan Kettering Cancer Center, New York, reports on the study in the journal NEJM.

"It would be a special study if those affected managed to do without further cancer therapies in the long term," says Susanne Weg-Remers from the Cancer Information Service of the German Cancer Research Center (DKFZ).

But she still sees a big question mark as to whether this hope will actually be confirmed.

"The follow-up time is still too short."

All study participants had rectal tumors with a so-called mismatch repair deficiency, which means that correction processes when copying genetic material in the cells are impaired.

According to the authors of the study, around five to ten percent of rectal tumors fall into this group, which responds comparatively poorly to classic chemotherapy.

The positive study result cannot therefore be applied to all rectal tumors, let alone to all cases of colon cancer or even cancer in general.

The immune system is boosted

The active substance dostarlimab interferes with the communication of the immune system.

In principle, the immune system can fight modified cells in the body, including cancer cells.

But these, in turn, can send out signals that leave them alone, allowing the tumor to continue growing.

Dostarlimab ensures that the immune system can override the braking signals.

Incidentally, two immune researchers received the Nobel Prize in Medicine in 2018 for the fundamental findings behind these processes.

Strengthening the immune system is not necessarily without side effects.

Although no serious complications occurred in the small study, these are known from other studies.

The drug package insert also warns of immune-mediated side effects that can be serious or fatal.

In the EU, dostarlimab already has conditional approval for the treatment of certain forms of cervical cancer with a mismatch repair deficiency.

In the approval study, a good 40 percent of the patients responded to the treatment.

The drug is currently expensive, the drug costs can be around 100,000 euros for one year.

Before approval of dostarlimab for rectal cancer can be considered, a larger, so-called phase 3 study must be available in which the drug proves its effectiveness - and that will take time.

Source: spiegel

All life articles on 2022-06-09

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