Throughout the long history of cancer, spanning more than 3,500 years, humans have always tried to find an effective and definitive treatment that eliminates the disease and prevents its recurrence.
But humanity was more likely to win, and cancer to be more likely, and with every effective treatment came severe side effects, which were sometimes worse than the disease itself.
But it may be time for some types of cancer to be completely defeated, as humanity seems to have taken a very significant leap in its very long battle against cancer, using a relatively new treatment method that is unprecedented and effective to an extent, at least for the moment.
Exciting study
The study, published on June 5, in the prestigious "The New England Journal of Medicine", caused a stir in the scientific community, after the results of one of the clinical trials of the drug "Dostarlimab" on patients with... Rectal adenocarcinoma resulted in a cure rate of 100% for all subjects, an unprecedented result that has never been seen before in the history of cancer studies (1).
The study was conducted on a small group of patients with stage II or III rectal cancer, who suffer from a deficiency in the "mismatch repair" gene that causes the tumor, to take a dose every 3 weeks for 6 months, followed by doses of chemotherapy Or radiological or surgical, if necessary.
The cases of “mismatch repair” gene deficiency represent 5-10% of rectal cancer cases, and this type in particular does not respond well to radiotherapy or chemotherapy, forcing many patients to undergo a surgical solution, by removing the tumor and surrounding tissues, and the consequent Loss of control over the excretory process and damage to the nerves passing through the area (2).
Therefore, this relatively new drug was a lifeline for this category of patients, especially in the second and third stages, when the tumor spreads to the tissues surrounding the rectum, and before it began spreading to distant organs in the body.
new drug
The drug "Dostarlimab" produced by the company (GSK) (communication sites)
The Food and Drug Administration (FDA) gave Glasgow Pharmaceutical Company (GSK) Expedited Approval for Dustarlimab to treat advanced solid carcinomas in August 2021. The drug was released under the name Jemperli as a liquid. Transparent, injected into a vein, and is subject to continuous studies to monitor its effect on different types of cancer, such as endometrial cancer, lung cancer, and digestive system cancers (3).
The drug belongs to the family of "immune therapy" drugs, which in recent years have shown promising results in the treatment of cancerous diseases, and the most recent achievements were awarded a Nobel Prize several years ago.
Immunotherapy helps and boosts the natural immune system so that it can find and then kill cancer cells, without the drug attacking the tumor itself (4).
Dustarlimab consists of antibodies to a protein called programmed death 1 (PD-1).
In normal cases, this protein works to inhibit a type of "T-cells" (T-cells) to protect the body from autoimmune diseases, meaning it prevents the body from attacking itself.
But in cases of cancerous tumors, the tumor uses this protein to hide from the immune system and protect itself from the attack of the immune system, so that the malignant cells multiply and grow safely.
Therefore, disabling this protein with the drug makes cancer cells exposed to the immune system again, particularly those that are missing the mismatch repair gene (6).
In normal cells, the mismatch repair gene repairs mutations resulting from transcription errors. During cell division and transcription of DNA letters, some letters may be mistyped, and the accumulation of these errors leads to gene mutations, which may be silent and benign, It may lead to malignant tumors.
Some patients with cancer, especially colon and endometrial cancer, suffer from a deficiency in this vital gene, which prevents correcting errors resulting from dividing in the first place, and makes their cells vulnerable to repeated mutations.
This type of cancer may be resistant to conventional treatments, so this particular group of patients is interested in immunotherapy (7).
The study sample consisted of 12 people followed for at least 6 months after the end of drug doses, and the researchers found no effect of tumors in any of the participants, whether using manual examination, endoscopic examination, magnetic resonance, atomic scanning, or even taking a sample of the location of the tumor.
Of course, this result led to the exemption of all participants, without exception, from completing chemotherapy or radiation, because there was no longer a trace of tumors completely.
In addition to the disappearance of the primary tumors, after a follow-up of 6-25 months, there was no relapse or progression of the disease in any of the cases, and as of the date of the study's publication, none of the participants had undergone radiotherapy, chemotherapy, or surgery.
malicious visitor
Another reason for the weight of this study and its extreme importance is related to the nature of the disease itself. Colorectal cancer occupies the third place in the world in terms of prevalence, and it is also the third most prevalent cancer in men, and the second most prevalent in women after breast cancer (8).
There is no one sure cause for the occurrence of this type of cancer, but there are many biological and environmental factors that increase the chances of developing the disease, such as having a family history of infection, or a personal history of polyps in the colon, which may later turn into a malignant tumor. Just being an old person.
Elderly people are more likely to get colorectal cancer
There are also factors that can be controlled such as excess weight, lack of movement and the type of diet followed, as diets rich in red meat increase the chances of contracting this disease, in addition to smoking and drinking alcoholic beverages (9).
This does not mean that the disease does not affect younger people, since only 12% of annual cases in the United States are detected in people younger than 50 (10).
For more, read: Eating a healthy diet.. Steps to prevent colorectal cancer
In the year 2020 alone, nearly a million people lost their lives as a result of colon or rectal cancer, and this disease is the second largest cause of death among cancer patients.
The usual course of treatment for patients with colon cancer in the second and third stages was the use of chemotherapy and radiation in the first step, and sometimes the use of both at the same time, and then resorting to surgical resection as a last resort in case the first attempts failed (11).
About 37% of colorectal cancer cases are detected early in the first stage, and the tumor is usually excised laparoscopically with relative ease, so the success rates in dealing with the disease reach 91%.
But if cancer spreads to tissues around the colon or nearby lymph nodes, survival rates drop to 72 percent, and this group accounts for about a third of cases.
As for late cases of the disease, in which the malignant cells spread to various parts of the body, the survival rates do not exceed 15% (12).
People hope to get rid of cancer
The results of this new study offer hope to a large number of colorectal cancer patients, as it gives them more effective medicine than radiotherapy and chemotherapy, and it gives them a safer treatment, as the study did not monitor the occurrence of any side effects in the research samples, in contrast to the annoying and dangerous side effects of types of cancer. previous treatment.
Not only that, but the new drug not only eliminates the malignant tumor, but also prevents the disease from recurring or returning again, and this is a medical breakthrough, no doubt.
The new drug provides a more effective and safer treatment than traditional treatments
In general, previous studies conducted on immunotherapies had good and promising results.
In the study published in The Lancet, pembrolizumab, which works similarly to dustarlimab, was tested on colon cancer patients with a lack of the incompatibility repair gene.
By comparing the results of this drug with the results of conventional chemotherapy, it was found that chemotherapy gives 8 months of stabilization of the disease, while the drug gives patients 16 months in which the disease does not progress.
The research samples were followed for about 44 months, and it was also noted that the side effects of the drug were much less severe than those of chemotherapy (13).
In another study, nivolumab, which belongs to the same family as dustarlimab, had a disease-free survival rate of 48.4% after one year, in addition to that the drug did not cause serious side effects.
We are talking about cases of advanced colon cancer that has spread throughout the body, so this percentage is very promising compared to other treatment methods in such cases (14).
research problems
But despite the impressive results of the study of the drug “Dostarlimab”, which exceeded the results of all previous studies, the small sample size makes it insufficient to determine whether this drug is really effective and safe or not. This experiment needs to be repeated again, and on a larger sample of cases Until the results are confirmed, but this does not preclude that the results are promising and call for hope.
With the dawning of each new day, humanity is making a small step towards curing and ending the pain of different types of cancer, and as it has succeeded before in dealing with many types of cancer, and giving survivors a second chance to live, it will one day succeed in winning this fierce battle against all cancer, which is Not a single disease, but a complex syndrome of many diseases.
Perhaps the day will come when a cancer patient does not have to undergo harsh chemotherapy, and suffer with nausea, wasting and hair loss, perhaps we can soon see a cancer patient recover within a few months and return to a simple normal life. Scientists are on their way to victory.
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Sources:
1- PD-1 Blockade in Mismatch Repair–Deficient, Locally Advanced Rectal Cancer |
NEJM
2- Experimental rectal cancer drug caused all patients' tumors to disappear in small trial |
Live Science
3- Jemperli (dostarlimab-gxly) for the Treatment of Advanced Solid Tumors
4- What is Immunotherapy?
|
Cancer.Net.
5- GSK presents positive efficacy data of dostarlimab in mismatch repair-deficient (dMMR) solid cancers at ASCO Gastrointestinal Cancers Symposium
6- Programmed death-1 pathway in cancer and autoimmunity
7- Definition of mismatch repair deficiency - NCI Dictionary of Cancer Terms
8- Colorectal cancer statistics |
WCRF International
9- Colorectal Cancer Risk Factors
10- Colorectal Cancer Facts & Figures 2020-2022
11- Rectal Cancer Treatment, by Stage |
How to Treat Rectal Cancer.
12- Colorectal Cancer: Statistics |
Cancer.Net.
13- Pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer (KEYNOTE-177)
14- What is the role of nivolumab in the treatment of colon cancer?