When a person develops solid tumors in the stomach or esophagus or rectum, oncologists know how to treat them. But care often have serious effects on the quality of life. This may include the removal of the stomach or bladder, a permanent colostomy bag, radiation that makes patients infertile and last lasting from chemotherapy.
So a research group at the Memorial Sloan Kettering Cancer Center, using a drug of the GSK pharmaceutical company, has tried something different.
The researchers started with a group of 103 people. The participants in the study were between 2-3 percent of patients with cancer with tumors who should respond to immunotherapy, a drug that exceeds the barriers that prevent the immune system from attacking tumors.
But in clinical studies, immunotherapy should not replace standard treatments. The researchers, led by Dr. Luis A. Diaz Jr. and by Dr. Andrea Cercek, decided to give Dostarlimab, a drug for immunotherapy, alone.
The result was surprising and could lead hope to the limited cohort of patients competing for these tumors.
In 49 patients, who had rectal cancer, the tumors disappeared and, after five years, did not recover. The tumors also disappeared for 35 out of 54 patients who had other tumors, including the stomach, the esophagus, the liver, the endometrium, the urinary tract and the prostate.
Of all 103 patients, the tumors recovered in just five. Three have obtained further doses of immunotherapy and one, whose cancer recovered in a lymph node, removed the lymph node. Those four patients so far have no disease tests. The fifth patient had an additional immunotherapy that the tumor was reduced.
Investigators reported their results on Sunday during the annual meeting of the American Association for Cancer Research and in an article published in the New England Journal of Medicine.
The results, said dr. Bert Vogelstein, Johns Hopkins' oncologist in Baltimore, are “revolutionaries”.
The previous phases of the drug development occurred in his laboratory and saw his progress with amazement.
“Twenty or 30 years ago, the idea of being able to take great tumors of many different organs and treating them without making surgery would seem a science fiction,” he said. But, he added, the discovery did not come completely into the researchers' mind. Instead, he observed, it is based on 40 years of research “starting from very basic sciences”.
The reason why immunotherapy has even a possibility against these great tumors is because patients' tumors had what is known as mutations of repairing the lack of correspondence in their genes that prevented them from setting the damage to DNA. Consequently, these tumors are stormed with unusual proteins that report the immune system to destroy them. But the tumors have put on a shield that blocks the attacks of the immune system. Immunotherapy pierces the shield and allows the immune system to destroy tumors.
For patients like those of the study, said Dr. Michael Overman, a specialist in gastrointestinal cancer at the Houston MD Anderson Cancer, the results show immunotherapy without chemotherapy, radiation treatments or surgery is a valid treatment “and it is so logical that we should do it”.
But for now, it may not be so easy. The drug costs about $ 11,000 per dose and patients need nine infusions in six months. To obtain insurance coverage, the drug must be included in the clinical guidelines, a series of recommendations for treatments produced by professional organizations.
It is approved as a treatment for uterine tumors with repair mutations non -correspondence and is included in the clinical guidelines for the treatment of rectal carcinoma, based on a small previous study. But patients with other tumors may have difficulty obtaining the drug, said dr. Diaz. Memorial Sloan Kettering, however, is still recruiting for its clinical experimentation, therefore patients who have tumors with non -corresponding repair mutations and qualify for the study can free the drug.
For some patients, immunotherapy was miraculous. It can have side effects: the most common among patients in the study have been fatigue, rash and itching. Rarer side effects included lung and encephalitis infections.
Maureen Sideris, 71 years old, of Amenia, New York, discovered that she had cancer after trying to eat a hamburger.
“He wouldn't go down,” he said. There was a sort of block. It turned out to be a tumor at the time of the stomach and esophagus.
He went to Sloan Kettering in 2022
But his tumor had a non -corresponding repair mutation, so he joined the clinical study. The first infusion was on October 14 of that year. In January, his tumor was disappeared. Mrs. Sideris has a side effect from the treatment: now she has to take drugs to improve the functioning of her adrenal glands. But it says it is worth paying that price to avoid the onerous treatment that would have been in store for her.
“It was a journey,” he said. But, he added, he thought he had nothing to lose when he agreed to try immunotherapy.
“I still had surgery like backup if it didn't work,” he said.