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?


Indian cancer doctors talk about the miracle drug ‘Dostarlimab’ trial that completely removed cancer: Do we have a cancer cure in sight?

India's cancergrowth rates are among the global highest, as per the Cancer Statistics report. Cancer cases increased at an average annual rate of 1.1-2 per cent from 2010-2019. As the world grapples with the burden of the dreaded ‘C’ word, the news of a drug trial having miraculously removed tumors from a few patients who took a drug called Dostarlimab bought some ray of hope. It was a small clinical trial where patients with rectal cancer were put on immunotherapy for 6 months. Now this brings us to the question if we can finally hope for a cancer treatment for all cancers? Is the cancer cure near or will we still have to wait before the cure reaches all? We spoke to leading oncologists from the country to know their thoughts on the new trial…

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.

New Delhi:
  The findings concerning dostarlimab, an antibody drug, in experimental treatment of rectal cancer patients is very encouraging but there is need for long-term studies to understand the real impact, an expert in cancer treatment has said. "This new trial at MSKCC in a small number of patients, with locally advanced rectal cancer patients who had MMR (MisMatch repair) deficiency, have shown total disappearance of tumour without any additional treatment in all 100 percent of them. This is very encouraging but we must note that long term studies are required to understand the real impact," Dr. (Col.) R. Ranga Rao, Chairman, Oncology, of Paras Hospitals in Gurugram said. "The drug is still investigational and the trial is limited to patients of a specific type , that constitute about 4 to 5 per cent of rectal cancers. While this is highly encouraging, we must not prematurely jump to conclusions that we have found a cure for all cancers, all stages, and no chemotherapy, surgery is ever required," he added. 

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.



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