Dostarlimab is the name of a drug that has been used as a synonym for the word “hope” starting this week on social media platforms to “cure” cancer. One study described as a “massive breakthrough” found the drug helped treat rectal cancer — for the first time in history.
In all 12 patients, rectal cancer disappeared after six months of immunotherapy without the need for standard treatments of radiation, surgery, or chemotherapy.
Made by GlaxoSmithKline, dustarlimb is not a “new” drug.
It was approved for use in the United States and the European Union in April 2021 and is used to treat endometrial cancer, solid tumors that have developed or after previous treatment, and for those without satisfactory alternative treatment options.
The drug, a monoclonal antibody marketed under the brand name Jemperli, works by changing the way the body’s immune system works.
While the results of the experiment are encouraging, science experts would like to buy more time before declaring victory over cancer.
Separating the hype from the truth, the trial results published in the New England Journal of Medicine, Scientifically, concluded that “longer follow-up is necessary to assess response duration.”
The NEJM article clearly outlines the limitations of the study. However, he does not talk about costs. The problem is that the results of the study have been greatly exaggerated and exaggerated. “People are wondering if modern science has finally found a cure for cancer,” Dr. SP Kalantari, Professor of Medicine and Medical Supervisor at Mahatma Gandhi Institute of Medical Sciences, Sivagram, wrote on Twitter. People are so busy forwarding WhatsApp messages that all cancers will soon be gone. These blanket generalizations do more harm than good.”
Here are six reasons why it’s too early to believe cancer has a cure now:
1. If successful, it is intended for a very small subset of patients
According to Dr. C.S. Pramesh, Director of the Tata Memorial Center, a well-known medical institute for cancer treatment in India, “MMR-deficient rectal cancers account for less than 10% of all rectal cancers.”
“This subgroup of patients was selected because they are exquisitely sensitive to immunotherapy. This means that the results apply to a small percentage of all rectal cancer patients,” he wrote on Twitter.
Overall, according to ICMR, in India, the annual incidence of rectal cancer in men is 4.1 lakhs.
2. The cost of treatment is not applicable
Dr Bramish further writes that “the cost of treatment is not insignificant – the total treatment costs for nine doses of the drug (given during the study) are expected to be anywhere from Rs 50,000 to Rs 1 crore (US$100,000), which puts him far from accessible to most patients in low- and middle-income countries.
Low and middle income countries are low and middle income countries, including India.
“If the drug is useful in future studies, the cost must come down to make it accessible to the vast majority of cancer patients – let’s not forget that 70% of all cancers are expected to occur in low- and middle-income countries.”
3. There is no information regarding remission, yet
Public health expert Dr. Ash Ball believes that “very little is known about the length of time needed to know whether a complete clinical response to dostarlimb equates to treatment or whether patients are in remission…”
The median follow-up is believed to be still short with a median of 6.8 months.
“We know from the OPRA experience that 88% of tumor regrowth can occur two years after completion of TNT [total neoadjuvant therapy],” He said.
OPRA is an acronym for a US-based trial called Organ Preservation in Rectal Adenocarcinoma.
“Very little is known about the length of time needed to know if a complete clinical response to dustarlimb is equivalent to treatment,” he said.
Finally, the only endpoint now available is an overall response, with no data on survival or other clinically relevant outcomes.
4. The small size of the study sample
The study, which was a phase II trial, was conducted on only 12 patients. Experts suggest that these findings should be replicated in a larger trial involving patients from diverse racial and ethnic backgrounds.
“Although the initial signs are positive, we need to go a long way before we can call it a magic drug,” said Dr JP Sharma, Head of Department and Senior Consultant in Medical Oncology at Action Cancer Hospital in Delhi.
It is not a new drug but a combination of drugs already approved and used in immunotherapy around the world. Some of the drugs used in this group have already shown positive results when used individually to treat certain cancers.”
5. One central results
All patients were enrolled in only one center – the MSK Cancer Center. Experts noted that the US-based institute “has extensive experience in the management of rectal cancer.”
Its website claims to have specialists from all areas of rectal cancer care who will design a personalized plan for patients. Our areas of expertise include surgery, chemotherapy, radiotherapy, rehabilitation, follow-up care and quality of life issues. Having all of our MSK experts together helps ensure that you choose the best combination of treatments for your cancer treatment and give you the best possible outcome.”
6. Success may not be the same in phase III or other cancer trials
While it has been described as a “first in history” type of cancer treatment, experts suggest caution and prefer to trust the science and process.
The trial results may lead to similar results in other cancers and may not lead to similar results, therefore, it is too early to announce a cancer treatment as such.
In his video explanation on his YouTube channel, Dr. Vinay Prasad, a hematologist and oncologist at the University of California, San Francisco, described the results of the experiment many times as impressive. However, he doesn’t think the success of the trial can be replicated with other cancer treatments either.
“I doubt it would (that) it would work so admirably (in other cancers) … (recent results) are impressive, like you might have found a sweet spot,” he says. “Just cherish it.”
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