Indian cancer doctors talk about the miracle drug ‘Dostarlimab’ trial that completely removed cancer: Do we have a cancer cure in sight?
Indian cancer doctors talk
about the miracle drug ‘Dostarlimab’ trial that completely removed cancer: Do
we have a cancer cure in sight?
Dr. Sajan Rajpurohit, Director - Medical Oncology
at BLK Max Super Speciality Hospital
This trial was done in twelve patients and they
published the data, results of which are now known internationally. This drug
is actually useful in a subset of rectal cancer patients which have one
specific genetic abnormality which is known as MMR, which is known as mismatch
repair gene deficiency. So these patients respond very nicely to this
monoclonal antibody. It is a kind of antibody, which works by improving the
body's immunity, and it helps the body's own immunity to go and kill the cancer
cells. The results are really very fascinating because all the 12 patients had
a very good response, and at six months, no tumor was seen in their body. So
the results are very encouraging. How I see this result is that, though this is
a phase two data which we have, it looks like a very effective treatment for
this subset of patients. And among all the patients of cancer, there'll be 5%
patients who have this kind of deficiency in the cancer cells. So in these
kinds of tumors, drugs like this can work marvelously. So with respect to cancer cure, cancer is very much
curable, specially in stage one, sometimes in stage three too. Only stage four
is where we really struggle with cures. But then with these new antibodies
which are targeting specific gene abnormalities in cancer cells, we are
reaching clarets of functional cures even in stage four cancer patients.
Dr. Wesley M Jose, Clinical Associate Professor, Medical Oncology, Amrita Hospital, Kochi
This is an
important trial to prove the concept of tailoring cancer treatment according to
individual patients. This trial drug (Dostarlimab) however is not the panacea
for all cancers. Dostarlimab is an immunotherapy drug. Immunotherapy drugs have
become another pillar of cancer care in recent years. There are many drugs
(Pembrolizumab, Nivolumab, Atezolizumab, Ipilimumab etc) similar to Dostarlimab
in the market now including Indian market and will be available in a cancer
center near you. But all these drugs are meant for very specific indications.
The 12 patient trial is a very small trial (called
phase 2 trial) and has been done in patients with cancer of the rectum (theterminal parto f the large intestine). All these patients were unique as their
cancer was deficient for a gene called mismatch repair. The people with this
kind of gene abnormality are more sensitive to treatment with immunotherapy.
That is the reason for such a response to the treatment. The reason why there
has been no side effects is because the case numbers are very low and the
treatment period is relatively short. Dostarlimab may turn out to be a very
important drug in the oncologists armamentarium, but it is unlikely to be a
magic bullet.
The bigger concern currently is the cost of the
immunotherapy drugs. A paper presented by Tata Memorial Hospital in the same
meeting where Dostarlimab data was presented, reported that only three percent
of Indian patients are able to even afford these drugs which is quite a sorry
state of affairs. We need not just the drugs but also policies which make these
drugs affordable and available to common people. That is a tall order.
As for how soon we will have a cure, it is a hope
of every cancer scientist and every cancer research. Only time will tell…
Dr. Sachin Almel,
Section Co-ordinator of Medical Oncology, P.D. Hinduja Hospital & Medical
Research Centre, Mumbai
It was experimented for rectal cancer with 12
patients, so it is early to say it can be pathbreaking but it is definitely
something as these results have never been seen in clinical trials. It is quite
interesting to see how these Immuno checkpoint inhibitors have worked and the
12 patients were found to be cancer free.
We need to be mindful regarding this trial, there
was a small set of people who it worked for, plus a very small percentage of
patients suffering from rectal cancer would be apt for this treatment. But this
is definitely a start towards more effective cancer care.
Dr. Shishir Shetty, Senior Consultant – Surgical Oncology, Apollo Cancer Centre, Mumbai
The news of
Dostarlimab, a new hope, a revolution in cancer treatment which was presented
at ASCO has kept my phone ringing for the last few days. The study has been
tested on a very few numbers of patients which is 12. I believe a larger study
is needed to go ahead with clinical implementation. The approximate treatment
cost would be upwards of 1.5 crores.
Only a few
selective types of cancers with particular biology (MMR deficient) would be
eligible (approx 5% of all tumors not all). No doubt it’s a revolution in
cancer cure and is going to pave the way for more research and the quest for
cancer cure without any chemotherapy/radiation or surgery.
However, I believe that treatment should be well tested in terms of time and application to have strong credibility. Till date, surgery is the simplest, cheapest and most effective treatment for solid tumors.
He said it is well recognized that Immunotherapy with PDL 1 blockers in MMRd patients is effective. "Already immunotherapy has made a big difference in the field of cancer of all types. Several earlier trials have shown encouraging responses," Dr Rao said. In what appears to be a miracle and 'first time in history', a small clinical trial has found that every single rectal cancer patient who received an experimental treatment found that their cancer had vanished. According to New York Times, in the small clinical trial conducted by Memorial Sloan Kettering Cancer Center, 18 patients took a drug called Dostarlimab for around six months, and in the end, every one of them saw their tumours disappear.
Dr Luis A. Diaz J. of New York's Memorial Sloan Kettering Cancer Center (MSKCC) said this was "the first time this has happened in the history of cancer". According to experts, Dostarlimab is a drug with laboratory-produced molecules and it acts as substitute antibodies in the human body. The cancer is undetectable by physical exam; endoscopy; positron emission tomography or PET scans or MRI scans, added Experts. This proves that Dostarlimab can be a 'potential' cure for one of the most deadly common cancers.
According to New York Times, patients involved in the clinical trial earlier underwent treatments such as chemotherapy, radiation, and invasivesurgery that could result in bowel, urinary, and even sexual dysfunction. The 18 patients went into the trial expecting to have to go through these procedures as the next step. However, to their surprise, no further treatment was needed.
The findings of this trial have shocked experts and they have pointed out that complete remission in every single patient is "unheard-of".
Dr Alan P. Venook, who is a colorectal cancer specialist at the University of California, said that the complete remission in every single patient is "unheard-of". He hailed the research as a "world-first".
Experts stated that the research was impressive as not all of the patients suffered significant complications from the drug trial.
