What?
A recent clinical trial has seen every single participant cured of their cancer in what’s being described as a landmark world first. Researchers at Memorial Sloan Kettering Cancer Center in New York have published results of a trial assessing the effects of an immunotherapy drug, Dostarlimab, on locally advanced rectal cancer. 12 patients with rectal cancer with only local growth (that had not metastasised, i.e spread), were included in the trial, and were each given the trial drug every 3 weeks for 6 months.
At the end of the follow-up period (6-25 months), all patients had no sign of remaining cancer on either imaging or physical examination. This is the first time in history that all patients in a clinical trial assessing the effects of an anti-cancer treatment have reported a complete response. The patients did not undergo chemotherapy or surgery.
Why?
Clinical trials are a fundamental part of medicine, and especially so in cancer medicine. They assess the effects of new drugs and treatments and compare the effects to the current ‘standard of care’, i.e. treatments that we already know are effective. In this case, researchers trialled a type of drug called immunotherapy at a cancer stage where the standard of care is usually chemotherapy, radiotherapy, surgery or a combination of all three.
While effective, these three treatments often carry a significant burden of side effects including nausea and vomiting, hair loss and infections, to name but a few. The rationale of this trial was to use a type of immunotherapy drug that is often used after other treatments have failed, to see if a lasting cure could be found earlier, without exposing a patient to the risks of the current standard of care.
Immunotherapy harnesses the immune system to attack cancer cells and is not a new innovation. The first documented use occurred in 1891 when William B. Coley, MD cured a man’s throat cancer with the use of bacteria. However, modern immunotherapy such as Dostarlimab is a world away from these humble beginnings.
Your immune system is constantly on the hunt for foreign cells to remove. If the cell is not recognised as ‘you’, it is killed, so your own cells have small signs, or checkpoints. These tell the immune system that they are friendly and shouldn’t be killed. But certain cancer cells are able to forge these signs and fool the immune system into thinking they too are friendly. Drugs like Dostarlimab are called checkpoint inhibitors. They expose cancer cells to the immune system by blocking these checkpoints, and they are then killed and mopped up, treating the cancer.
How (does it affect you)?
This research is a staggering breakthrough and demonstrates the effectiveness of immunotherapy even in early-stage cancer that has not yet spread. It also seems to challenge the current model of chemotherapy, radiotherapy and surgery as first-line treatments for cancer. Immunotherapy drugs are notable for their rapid and widespread effect on tumours. Metastatic melanoma had previously been viewed as a death sentence, but immunotherapy drugs have revolutionised its treatment.
However, immunotherapy is not without side effects. Checkpoint inhibitors can also affect the checkpoints of our own cells, leading to the immune system attacking the body it is meant to protect. Side effects of immunotherapy can range from mild to severe, and may even result in death, and patients taking these types of drugs should be aware of early warning signs of a reaction. It should also be noted from this trial that follow-up is ongoing, therefore the cancer in these patients may come back in the future. Researchers in this trial have been hesitant to call it a ‘cure’.
Checkpoint inhibitors are a new technology in immunotherapy. Researchers continue to experiment with appropriate doses to minimise side effects, and monitor patients to assess the length and amount of response to treatment.
If you or a loved one is suffering from cancer, this breakthrough will be encouraging news. Nevertheless, it is a small scale trial with follow-up still ongoing, and guidelines to include it in standard treatment regimes will not be introduced in the UK for a while. Immunotherapy is offered in the NHS and your oncologist should be able to give you more information about this treatment and check if you are eligible. For more tips on cancer care in the NHS, read myHSN’s top tips on cancer care.
As always, best wishes from myHSN!
