Immunotherapy medication saves cancer patients from gruesome operations and hard therapies

When a person develops solid tumors in the stomach, in the esophagus or in the rectum, oncologists know how to be treated. But the remedies often have serious effects on the quality of life. This can be removed from the stomach or the bladder, a permanent colostomy bag, radiation, the patients into sterile and permanent damage caused by chemotherapy.

A research group of the Memorial Sloan Kettering Cancer Center, which uses a drug from the pharmaceutical company GSK, tried something else.

The researchers started with a group of 103 people. The participants in the study were among the 2 to 3 percent of cancer patients with tumors that should respond to immunotherapy, a medication that overcomes obstacles that prevent the immune system from attacking cancer.

In clinical studies, however, immunotherapy should not replace standard treatments. The researchers under the direction of Dr. Luis A. Diaz Jr. and Dr. Andrea Cercek decided to give dostarlimab, an immunotherapy medication alone.

The result was breathtaking and was able to bring hope of the limited cohort of patients who fight with these types of cancer.

In 49 of the patients who had rectal cancer, the tumors disappeared and have not resumed after five years. Cancer also disappeared for 35 out of 54 patients with other types of cancer, including in the stomach, the esophagus, the liver, the endometrium, in the urinary tract and the prostate.

Cancer species of all 103 patients performed in just five. Three received additional immunotherapy sockets and one whose tumor reappeared in a lymph node, made the lymph node removed. So far, these four patients have no signs of illness. The fifth patient had additional immunotherapy that let the tumor shrink.

The investigators reported their results on Sunday at the annual conference of the American Association for Cancer Research and in a work published in the New England Journal of Medicine.

The results, according to Dr. Bert Vogelstein, oncologist at John's Hopkins in Baltimore, are “groundbreaking”.

Earlier phases of the development of the drug occurred in his laboratory and he was surprised by its progress.

“Twenty or 30 years ago, the idea that they take large tumors of many different organs and treat them without surgery seems to be science fiction,” he said. But he added that the discovery did not go into the heads of the researchers. Instead, he noticed, it builds on 40 years of research, “starting with very basic science”.

The reason why immunotherapy even had a chance against these large tumors is that the tumors of the patients in their genes, which are called false pairing repair mutations, prevented them from fixing DNA damage. As a result, such tumors are occupied with unusual proteins that signal the immune system to destroy them. But tumors set up a sign that blocked attacks by the immune system. Immunotherapy pierces the shield and enables the immune system to destroy the tumors.

For patients and patients in the study, Dr. Michael Overman, specialist for gastrointestinal cancer at the MD Anderson Cancer Center in Houston, show the results immunotherapy without chemotherapy, radiation treatments or operations is a valid treatment “And it is so logical that we should do it.

But for the time being, it's not that easy. The drug costs around 11,000 US dollars per dose and patients need nine infusions over six months. In order to obtain insurance coverage, the drug must be included in clinical guidelines, recommendations for treatments created by professional organizations.

It is approved as the treatment of uterine cancer with Mismatch repair mutations and contained in clinical guidelines for the treatment of rectal cancer based on a previous small study. However, patients with other types of cancer could have problems getting the medication, said Dr. Diaz. However, Memorial Sloan Kettering is still recruiting for his clinical study, so that patients with non -matching repair mutations have tumors and can qualify for the study, the medication -free can take free.

Immunotherapy was miraculous for some patients. It can have side effects – most often in patients in the study, tiredness, rash and itching. Rarer side effects included lung infections and encephalitis.

Maureen Sideris, 71, from Amenia, Ny, found that she had cancer after trying to eat a hamburger.

“It wouldn't go down,” she said. There was a kind of blockade. It turned out that it was a tumor at the intersection of her stomach and the esophagus.

She went to Sloan Kettering in 2019. Her surgeon told her that she had to be operated on, chemotherapy and radiation and the operation would be difficult – you may have to take a piece of her stomach and move her esophagus.

But her tumor had a Mismatch repair mutation, so she joined the clinical study. The first infusion was on October 14 of this year. Her tumor was gone until January. Ms. Sideris has a side effect from the treatment – she now has to take medication to improve the function of her kidneys. But she says it is worth paying this price to avoid the stressful treatment that would have been in stock for her.

“It was a trip,” she said. However, she added that she had nothing to lose when she agreed to try immunotherapy.

“I still had an operation as a backup if it didn't work,” she said.