an experimental treatment cured 100% of patients

This extremely promising, but small-scale study will need to be extended to confirm these hitherto impressive results.

At the end of a small-scale trial, a team of doctors from the Memorial Sloan Kettering Cancer Center (MSKCC), in the United States, published quite exceptional results; thanks to a new treatment, they managed to trigger an apparently complete remission in… 100% of their patients. A figure that leaves one wondering about the clinical potential of this approach, even if we must remain aware of the limits of the study.

This trial was conducted on 14 patients who all suffered from rectal cancer. For the first time, the researchers decided to test dostarlimab. It is a substance which, very vulgarly, makes it possible to unmask the tumoral cells to allow the immune system to identify them precisely and to destroy them; this treatment therefore falls into the category of immunotherapy.

Usually, this treatment is used to treat cancers of the uterine body. Its use in the context of rectal cancer was therefore quite exploratory, and did not present the slightest guarantee of results. But the sequence of events proved that it was an excellent intuition.

According to the New York Times, three-quarters of these patients suffered fromquite noticeable side effects. In particular, they described nausea and extreme fatigue, elements that are regularly associated with most cancer treatments. No wonder so far.

100% remission after several months of follow-up

After the treatment was completed, the patients should have undergone a final treatment with surgery or radiotherapy to rid them of the remnants of the tumour. But a major surprise awaited the researchers: they were therefore extremely surprised to find that the tumors had completely resorbed ! Whether by MRI, PET scan, endoscopy or biopsy, the conclusion was the same: none of the subjects showed the slightest trace of cancerous tissue after a follow-up period of one to two years.

The other interesting thing is that the 14 patients who went through the protocol all had specific tumor mutations. These mutations, called MMRd, only occur in 5 to 10% of rectal cancers, and they are known to make tumors particularly resistant to the usual treatments. Dostarlimab, on the other hand, seems to have made short work of it.

In clinician memory, this spectacular success is quite simply a unique case. This is in any case what says Dr. Luis A. Diaz Jr., one of the authors of the study quoted by the New York Times. “I believe this is the first time this has happened in the history of cancer.”, he breathes.

Suffice to say that it represents a true hope for patients with these cancers, whose treatment weighs particularly heavy on a daily basis because of the particular location of the tumour. “If immunotherapy can treat rectal cancer, eligible patients will no longer need to accept functional compromises to be cured“, explains Andrea Cercek, lead author of the study.

A limited study…for now

Researchers have also begun to explore the use of dostarlimab in other MMRD cancers, including stomach, prostate and pancreas. This is therefore very encouraging for the overall management of these cancers. Can we begin to cry victory? Are rectal tumours, and by extension all other cancers, about to be eradicated? Unfortunately, this is still far from being the case. Because even if this study is undoubtedly promising, it also has several important limitations.

To begin with, there is the scope of the study. This will not have escaped your notice: this trial currently concerns only 14 patients – a figure largely insufficient when it comes to drawing clear conclusions in public health. These exceptional results could very well be a stroke of luck. To determine whether this protocol is compatible with all rectal cancers, it will be imperative to test the molecule on a much wider range of patients as part of a large-scale clinical trial.

Moreover, the disappearance of the tumor in no way dispenses with long-term control. So far, the researchers have only followed their patients for two years; it will be just as important to check that the status quo is maintained over the long term to prevent the cancer from returning.

It is therefore necessary to remain cautious while awaiting the results of additional work; but whatever the case, this work is indisputably part of that which is gradually improving the management of this veritable scourge of public health. And that, we can only applaud with both hands.

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