Have We Found the Cure for Rectal (Or All) Cancers?
It is the talk of the town, and rightly so. The first cancer clinical trial performed at a major cancer center to show 100% effectiveness in cancer remission.1 This reality has shocked us all in the best possible ways.
In short, a trial of a recently approved immunotherapy drug known as Dostarlimab, a single-agent PD-1 blockade,has shown 100% effectiveness against mismatch repair deficient recurrent or advanced solid tumors. The 12 patients who participated in the study at Memorial Sloan Kettering in New York City showed complete remission of their rectal cancer without chemotherapy, radiation, or surgery.
“This is by all accounts an unbelievable achievement and some truly great news when there’s so much uncertainty in our world,” says Dr. Gregory Quatrino, our colorectal surgeon. “These results reverberate around the cancer world and throughout medicine. I do not know of any cancer study showing complete remission in all patients involved. In addition, it doesn’t seem as though any patients had serious side effects.”
What Is Immuno-oncology?
Immuno-oncology involves using the body’s own immune system to fight cancer. On a broader application, immunotherapy does the same to fight other diseases. Immunotherapy has been around for a couple of decades in some form or other, but a complete understanding of how it works and how to harness the immune system remains largely out of reach. Immunotherapy was thrust into the national spotlight during the COVID-19 pandemic as monoclonal antibodies, amongst other therapies, were shown to help severe Covid patients avoid the ICU and ultimately saved thousands from dying.
Immunotherapy works in a couple of different ways. It can either stimulate the body’s own natural defenses – its immune system – to attack specific cells (cancer cells). Scientists have also developed lab-derived substances to train and enhance the immune system. Again, while most of these therapies are experimental, this study shows that we are making progress and may soon see breakthroughs in other areas of cancer treatment.
The Limitations of the Study
As with every piece of good news in novel cancer treatment, there is always an asterisk. First, only 12 patients participated in the study, which is not enough to fully evaluate the effectiveness of the therapy for a wider population. It is also essential to understand that while these patients did not experience significant side effects due to this drug, the sample size is too small to rule out side effects in a larger population.
We must also consider that this particular therapy is approved for a subset of rectal cancer patients and that treatments such as these may not be effective for all rectal cancers. Nor may this kind of therapy be effective for the broader cancer patient population.
“Despite the obvious limitations of this study, I do see a great deal of hope and excitement for the future of immuno-oncology. This will save lives, and it gives us renewed excitement and motivation to find the most advanced and least invasive cancer treatments for our colorectal patients,” says Dr. Quatrino.
Most importantly, however, all our patients need to understand that prevention is still the number one focus for colon and rectal cancer. With small changes in diet, exercise, and lifestyle, we can prevent many cases of colorectal cancer. And it’s never too late. Reversing even a lifetime of bad habits will have positive results.
For those experiencing any colorectal symptoms, early diagnosis allows for the widest range of potential treatment options, so do not delay seeing your colorectal specialist.
In the meantime, let’s all take a moment to enjoy this incredible advancement in science and medicine and hope for a future in which all cancers, not just colorectal cancer, can be treated with this kind of effectiveness.
1 Cercek A, Lumish MA, Sinopoli JC, et al. PD-1 blockade in mismatch repair-deficient, locally advanced rectal cancer. N Engl J Med. Published online June 5, 2022. doi:10.1056/NEJMoa2201445