Cancer is not a disease. At least not in the traditional sense we give to this word. In reality, cancer is a large group of diseases, ailments, and diseases with only relative family resemblance. That’s why it’s such a terrible challenge, such a disproportionate medical challenge. Especially the worst cancers.

In locally advanced rectal cancer, for example, you have to remove the heavy balls. Its usual treatment requires not only neoadjuvant chemotherapy and radiation, but also surgical resection of the rectum, which permanently affects the patient’s digestive system. But what if just one drug is enough from now on?

Surprisingly good treatment. Andrea Cercek, an oncologist at the Memorial Sloan Kettering Cancer Center in New York, presented this at the American Society of Clinical Oncology annual meeting (and the latest issue of the New Journal of England of Medicine). ). Results showing that Dostarlimab, a monoclonal antibody that blocks the receptor for programmed cell death protein 1 (PD-1), “can achieve a complete clinical response in locally advanced rectal cancer with a lack of repair of mismatches.”

When we can’t repair the damage. The study focused on a very specific type of rectal adenocarcinoma (between 5% and 10%) caused by a deficiency in mismatch repair. What happens in these cases is that patients have certain mutations in a particular set of genes responsible for various DNA repair processes in cells. Without these repair processes, errors accumulate and this causes the growth of polyps and tumors at a fairly early age. Also, as if that weren’t enough, these tumors have been shown to respond poorly to standard chemotherapy regimens, including state-of-the-art procedures.

an alternative way. Reversing the problem, Andrea Cercek and her team realized that immune checkpoint blockade alone is highly effective in other colorectal cancers (both metastatic and treatment-resistant). We are talking about objective response rates ranging from 33% to 55% and long-term overall survival. On that basis, they had an idea.

“We hypothesized that blocking programmed death 1 (PD-1) with a single agent might be beneficial in locally advanced rectal cancer that is incapable of mismatch repair.” This is where dostarlimab comes into play. For six months, this treatment was administered in patients with stage II or III rectal adenocarcinoma. The result was impressive.

100% remission in six months. First of all, because according to the initial plan, patients after this treatment had to go through standard cycles of chemoradiotherapy treatment and surgery, but it was not necessary. Complete tumor remission was achieved in 12 of 12 patients who completed treatment. For clarity, I put it as a percentage: 100%.

And remission continues in all patients up to 25 months after dostarlimab treatment ends. Undoubtedly, patients need “longer follow-up to assess response time,” as the same authors point out. First of all, because the study was so small, it opens up a very interesting field for treating some of the deadliest cancers we know of.

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