Unexpected result of cancer test: remission of each patient

In this small test, only 18 patients with rectal cancer used the same medication.

But the results were astonishing. The cancer was absent in every patient who could not be identified by physical examination, endoscopy, PET scans, or MRI scans.

Dr. Luis A. Diaz Jr. A researcher at the Memorial Sloan Kettering Cancer Center, the author of an article in the New England Journal of Medicine on Sunday describing the results, funded by the drug company GlaxoSmithKline, said the treatment was unaware of any other study that completely eradicated cancer. each patient.

“I think this is the first time in the history of cancer,” Dr. said Diaz.

Dr. Alan P. Venuk, a colorectal cancer specialist at the University of California, San Francisco, who did not participate in the study, said he thought it was the first time.

The complete remission of each patient was “unheard of,” he said.

Patients with this rectal cancer underwent severe treatment — chemotherapy, radiation, and life-changing surgery that could likely lead to bowel, urinary, and sexual dysfunction. Some will need a colostomy bag.

They thought that they would have to go through these procedures after the study, because no one expected that their tumors would disappear.

But something unexpected happened: they did not need any further treatment.

“There were many happy tears,” the doctor said. Andrea Sercek, an oncologist at the Memorial Sloan Kettering Cancer Center, is the author of an article presented at the annual meeting of the American Society of Clinical Oncology on Sunday.

Another surprise, Dr. Venuk added that none of the patients had any clinically significant complications.

On average, every fifth patient has some adverse reaction to the medication they are taking, called dosarlimab, a checkpoint inhibitor. The drug is given every three weeks for six months and the dose is approximately $ 11,000. It opens cancer cells and allows the immune system to detect and destroy them.

Although most adverse reactions are easily managed, 3 to 5 percent of patients receiving checkpoint inhibitors have difficulty concentrating, in some cases leading to muscle weakness and difficulty swallowing and chewing.

In the absence of significant adverse effects, Drs. According to Venuk, “either they did not treat enough patients, or in some ways these cancers are completely different.”

In an editorial accompanying the newspaper, Dr. Hannah K., of the Leinberger Complex Cancer Center at the University of North Carolina. Sanoff called it “small but convincing” because he did not participate in the study. He added that it was unknown whether the patients had recovered.

“Very little is known about the length of time it takes to find out whether a clinical response to dostarlimab is equivalent to a complete cure,” the doctor said. Sanof said in an editorial.

Dr. Kimmy Ng, an expert on colorectal cancer at Harvard Medical School, said the results were “amazing” and “non-existent,” but should be repeated.

Inspired by a clinical trial to study colon cancer, Dr. Diaz was funded in 2017 by drug manufacturer Merck. It involved 86 people with metastatic cancer that had developed in various parts of the body. However, all of the cancers shared a gene mutation that prevented them from repairing DNA cell damage. These mutations occur in 4 percent of cancer patients.

In this trial, patients used pembrolizumab, a Merck checkpoint inhibitor, for up to two years. In one-third of patients, the tumor was reduced or stabilized and they lived longer. In 10% of the participants, the tumor disappeared.

This led to Dr. Cercek and Dr. Diaz asks: What if the drug was used much earlier in the course of the disease before it could spread?

They decided to examine patients with rectal cancer, which has spread to the rectum, sometimes to the lymph nodes, but not to other organs. Dr. Cercek found that chemotherapy did not help some of the patients with the same mutations that affected patients in the 2017 trial. Instead of shrinking during treatment, the tumor of the rectum grew.

Probably, Dr. Cercek and Dr. According to Diaz, checkpoint inhibitors and immunotherapy allow such patients to avoid chemotherapy, radiation, and surgery.

Dr. Diaz began asking companies that made checkpoint inhibitors if they could sponsor a small test. They refused, saying that the trial was too dangerous. He and Dr. Cercek wanted to give the drug to patients who could be cured with standard treatment. Researchers have suggested that cancer may grow to the point where it can be cured.

“It is very difficult to change the standard of care,” the doctor said. said Diaz. “All standard maintenance equipment wants to operate.”

Finally, a small biotechnology firm, Tesaro, agreed to sponsor the study. Tesaro was bought by GlaxoSmithKline and Dr. Diaz said he should have warned the bigger company that they were doing research – that company executives had forgotten the small test.

Their first patient was Sasha Roth, then 38 years old. She first noticed rectal bleeding in 2018, but was feeling better – she was running and helping run a family furniture store in Bethesda.

During sigmoidoscopy, her gastroenterologist said, “Oh, no. I wasn’t We look forward to it! ”

The next day the doctor called her. Roth. It was a tumor biopsy. “It’s definitely cancer,” he told her.

“I completely melted,” he said.

He soon planned to start chemotherapy at Georgetown University, but his friend insisted that he see Dr. Georgetown for the first time. Philip Patty Sloan at the Kettering Memorial. Dr. Pat told him he believed he had a mutation that would not respond well to chemotherapy for his cancer. But it turned out to be a lady. Roth was eligible to participate in a clinical trial. If he started chemotherapy, he would be gone.

Don’t wait for a full answer from my friend, madam. After the trial, Roth planned to move to New York for radiation, chemotherapy, and possibly surgery. After the expected radiation procedure, her ovaries were removed and placed back under her ribs to save the birth.

After the trial, Dr. Cercek told him.

“We looked at your scanners,” he said. “No cancer at all.” He did not need further treatment.

“I told my family,” she said. Said Roth. “They didn’t believe me.”

But two years later, she still has no cancer.

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