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A new immunotherapy has obtained unprecedented results against a particular type of colorectal cancer. According to the results presented at the ASCO 2024 congress, all of the 42 patients treated no longer showed any trace of disease.
A preliminary study on 12 patients which exceeded all hopes
The first results of this study hit the headlines during the ASCO 2022 congress to the point of being published in one of the most prestigious medical journals The New England Journal of Medicine. All 12 patients with some form of rectal cancer were in remission after receiving dostarlimab (marketed under the name Jemperli by GSK laboratories).
It is an immunotherapy, a PD-1 blocking antibody that blocks the PD1-PDL1 and PD-L2 pathway.19. A pathway normally used by cancer cells to escape the immune system.
This study concerns locally advanced rectal cancer and more particularly between 5 to 10% of them whose cells present anomalies capable of affecting the proper repair of DNA when it is copied in a cell. Schematically, these tumors present a great deal of genetic heterogeneity which normally makes them a good candidate for treatment with immunotherapies.
Two years later, the Memorial Sloan Kettering Cancer Center study was expanded to include 42 patients. Its results were presented at the ASCO 2024 conference.
No more signs of illness in the 42 patients treated!
And the results remain exceptional two years later even though the study included more patients. The trial showed an unprecedented complete clinical response rate of 100% in 42 patients. In the first 24 patients evaluated, a sustained complete clinical response with a median follow-up of 26.3 months was observed. Clearly, the 42 patients no longer show any signs of illness!
Knowing that no serious adverse effects (grade 3) have been reported, the option of dostarlimab should quickly appear as a preferred choice if these results continue to be confirmed in the long term.
As a reminder, the current standard of care for these patients is initial treatment with chemotherapy plus radiation followed by surgery to remove the tumor as well as parts of the intestine and/or surrounding tissue. This treatment is effective but does not prevent nearly a third of patients from ending up dying from cancer that has spread to other parts of the body (distant metastases). 2 In addition, long-term adverse effects have a significant negative impact on quality of life, including intestinal, urinary and sexual dysfunctions, secondary cancers and infertility.
Towards a change in the management of several cancers?
For Andrea Cercek, from MSK, and lead author of the study: “These results demonstrate the potential of dostarlimab-gxly as a novel approach to treat locally advanced dMMR rectal cancer that leads to complete and durable tumor regression without the need for life-altering therapy. As a clinician, I have seen first-hand the debilitating impact of standard dMMR rectal cancer treatment and am excited about the potential of dostarlimab-gxly in these patients.“.
This same characteristic of cancer cells is found in some forms of endometrial, colorectal, and other gastrointestinal cancers, but can also be found in other solid tumors. This drug is currently the subject of preliminary studies against these tumors. It therefore remains to be determined whether the same spectacular results can be observed.