For the first time, the effectiveness of a womb cancer drug undergoing clinical trial has left everyone shocked. The drug, Dostarlimab, has seemingly cured every participant in the trial. The small group of people suffering from rectal cancer witnessed that their cancer vanished after the experimental treatment. According to reports, the 18 patients in the small clinical trial took Dostarlimab for around six months and after over 12 months the doctors found that their cancer has disappeared.
According to experts, Dostarlimab is a drug with laboratory-produced molecules and it acts as substitute antibodies in the human body. Reportedly, all 18 rectal cancer patients were given the same drug and as a result of the treatment, cancer was completely obliterated in every patient. The cancer is undetectable by physical exam; endoscopy; positron emission tomography or PET scans or MRI scans.
Although the sample size of the trial is quite small, it definitely proves that Dostarlimab can be a potential cure for one of the most deadly common cancers. Dr. Luis A. Diaz J. of New York’s Memorial Sloan Kettering Cancer Center said this was “the first time this has happened in the history of cancer”.
According to reports, the patients involved in the clinical trial earlier underwent treatments such as chemotherapy, radiation, and invasive surgery that could result in bowel, urinary, and even sexual dysfunction. Moreover, the 18 patients went into the trial expecting to have to go through these as the next step. However, to their surprise, no further treatment was needed.
The findings of this trial has shocked experts around the globe and experts have pointed out that complete remission in every single patient is “unheard-of”.
Several experts have hailed the research as a world-first and highlighted that it is more impressive as not all of the patients suffered significant complications from the trial drug. Meanwhile, a co-author of the paper, oncologist Dr. Andrea Cercek, described the moment patients found out they were cancer-free.
During the trial, the patients took Dostarlimab every three weeks for six months. It is noteworthy that they were all in similar stages of their cancer. The cancer was locally advanced in the rectum but had not spread to other organs.
‘At the time of this report, no patients had received chemoradiotherapy or undergone surgery, and no cases of progression or recurrence had been reported during follow-up,’ researchers wrote in the study published in the New England Journal of Medicine on Sunday.
The scientists have maintained that the treatment looks promising, However, a larger-scale trial is needed to see if it will work for more patients and if the cancers are truly in remission.
Now this brings us to the question if we can finally hope for a cancer treatment for all cancers? Is the cancer cure near or will we still have to wait before the cure reaches all?
We spoke to leading oncologists in India to know their thoughts on the new trial.
Dr. Sajan Rajpurohit, Director – Medical Oncology at BLK Max Super Speciality Hospital
This trial was done in twelve patients and they published the data, results of which are now known internationally. This drug is actually useful in a subset of rectal cancer patients which have one specific genetic abnormality which is known as MMR, which is known as mismatch repair gene deficiency. So these patients respond very nicely to this monoclonal antibody. It is a kind of antibody, which works by improving the body’s immunity, and it helps the body’s own immunity to go and kill the cancer cells. The results are really very fascinating because all the 12 patients had a very good response, and at six months, no tumor was seen in their body. So the results are very encouraging. How I see this result is that, though this is a phase two data which we have, it looks like a very effective treatment for this subset of patients. And among all the patients of cancer, there’ll be 5% patients who have this kind of deficiency in the cancer cells. So in these kinds of tumors, drugs like this can work marvelously.
So with respect to cancer cure, cancer is very much curable, specially in stage one, sometimes in stage three too. Only stage four is where we really struggle with cures. But then with these new antibodies which are targeting specific gene abnormalities in cancer cells, we are reaching clarets of functional cures even in stage four cancer patients.
Dr. Wesley M Jose, Clinical Associate Professor, Medical Oncology, Amrita Hospital, Kochi
This is an important trial to prove the concept of tailoring cancer treatment according to individual patients. This trial drug (Dostarlimab) however is not the panacea for all cancers. Dostarlimab is an immunotherapy drug. Immunotherapy drugs have become another pillar of cancer care in recent years. There are many drugs (Pembrolizumab, Nivolumab, Atezolizumab, Ipilimumab etc) similar to Dostarlimab in the market now including Indian market and will be available in a cancer center near you. But all these drugs are meant for very specific indications.
The 12 patient trial is a very small trial (called phase 2 trial) and has been done in patients with cancer of the rectum (the terminal parto f the large intestine). All these patients were unique as their cancer was deficient for a gene called mismatch repair. The people with this kind of gene abnormality are more sensitive to treatment with immunotherapy. That is the reason for such a response to the treatment. The reason why there has been no side effects is because the case numbers are very low and the treatment period is relatively short. Dostarlimab may turn out to be a very important drug in the oncologists armamentarium, but it is unlikely to be a magic bullet.
The bigger concern currently is the cost of the immunotherapy drugs. A paper presented by Tata Memorial Hospital in the same meeting where Dostarlimab data was presented, reported that only three percent of Indian patients are able to even afford these drugs which is quite a sorry state of affairs. We need not just the drugs but also policies which make these drugs affordable and available to common people. That is a tall order.
As for how soon we will have a cure, it is a hope of every cancer scientist and every cancer research. Only time will tell…
Dr. Jagdeesh N Kulkarni, Director, Asian Cancer Institute – Cumballa Hill
Authors need to be complimented for designing and successfully conducting the Dostarlimab study in loco-regionally advanced rectal cancer patients. Further it has shown that mutilating surgery which ends in colostomy can be avoided. Moreover it has salutary effect in improving quality of life and preservation of self image. Despite the small number and short follow up, the result is exemplary and very encouraging . However this approach needs more numbers and longer follow up to reach standard of care. Lastly this study could be extended to other clinical settings e.g. bladder, bowel and oesophagus cancers to name a few.
Dr. Sachin Almel, Section Co-ordinator of Medical Oncology, P.D. Hinduja Hospital & Medical Research Centre, Mumbai
It was experimented for rectal cancer with 12 patients, so it is early to say it can be pathbreaking but it is definitely something as these results have never been seen in clinical trials. It is quite interesting to see how these Immuno checkpoint inhibitors have worked and the 12 patients were found to be cancer free.
We need to be mindful regarding this trial, there was a small set of people who it worked for, plus a very small percentage of patients suffering from rectal cancer would be apt for this treatment. But this is definitely a start towards more effective cancer care.
Dr. Shishir Shetty, Senior Consultant – Surgical Oncology, Apollo Cancer Centre, Mumbai
The news of Dostarlimab, a new hope, a revolution in cancer treatment which was presented at ASCO has kept my phone ringing for the last few days. The study has been tested on a very few numbers of patients which is 12. I believe a larger study is needed to go ahead with clinical implementation. The approximate treatment cost would be upwards of 1.5 crores.
Only a few selective types of cancers with particular biology (MMR deficient) would be eligible (approx 5% of all tumors not all). No doubt it’s a revolution in cancer cure and is going to pave the way for more research and the quest for cancer cure without any chemotherapy/radiation or surgery.
However, I believe that treatment should be well tested in terms of time and application to have strong credibility. Till date, surgery is the simplest, cheapest and most effective treatment for solid tumors.
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