Chapter 1: A Game-Changing Discovery

Dr. Luis A. Diaz Jr. is experiencing a profound moment in his career as he leads the charge in developing a novel immunotherapy treatment for rectal cancer. This innovative approach harnesses the body’s immune system to combat cancer, a concept Dr. Diaz has dedicated his career to exploring.

In a small-scale trial involving 12 patients, every participant treated with the checkpoint inhibitor dostarlimab saw their rectal cancer completely eliminated.

Is it possible to eradicate cancer without resorting to chemotherapy, radiation, or surgery? Indeed, this study focused on patients with a specific genetic mutation found in 4% of cancer cases, known as mismatch repair-deficient (MMRd) or microsatellite instability (MSI). According to Dr. Diaz, "An MMRd tumor loses the ability to repair certain mutations, leading to an accumulation that triggers an immune response against the defective cancer cells."

Dr. Diaz's remarkable findings were published in the New England Journal of Medicine, stemming from a clinical study sponsored by GlaxoSmithKline. He stated, "This may be the first instance in cancer history where every patient in a trial achieved remission."

Other experts have echoed his sentiments, with Dr. Alan P. Venook, a specialist in colorectal cancer at the University of California, San Francisco, commenting, "Achieving complete remission in every patient is truly unprecedented."

Before delving into the trial's extraordinary results, it’s essential to understand the background that led to these advancements.

It All Began with a 2017 Merck Clinical Trial

In 2017, Dr. Diaz conducted a clinical trial with 86 individuals diagnosed with metastatic cancer. These patients shared a gene mutation that impaired their DNA repair capabilities. This mutation, affecting only 4% of cancer patients, typically leads to poor outcomes with traditional chemotherapy, sometimes causing tumors to grow.

Funded by Merck, the trial utilized the "checkpoint inhibitor" pembrolizumab. Results showed that tumors shrank or stabilized in 33% to 50% of participants, with 10% experiencing complete tumor disappearance.

Dr. Andrea Cercek, an oncologist at Memorial Sloan Kettering Cancer Center, and Dr. Diaz reviewed these results and pondered: "What if we applied this cancer drug much earlier in the treatment process, before cancer could spread?"

A Small Study with Significant Outcomes

Dr. Cercek and Dr. Diaz turned their attention to patients with locally advanced rectal cancer that had not yet metastasized. These patients, sharing the same mutation as those in the 2017 study, had tumors confined to the rectum and associated lymph nodes. Previous chemotherapy had caused their tumors to worsen.

The doctors theorized that employing a checkpoint inhibitor like dostarlimab could provide an effective alternative to chemotherapy, radiation, and surgery.

However, they faced resistance from drug companies, who deemed the approach too risky. The prevailing standards of care mandated treatments involving chemotherapy, radiation, and surgery. If their trial yielded negative results, it would risk the established treatment protocols.

Ultimately, Tesaro, a subsidiary of GlaxoSmithKline, agreed to sponsor their trial using dostarlimab.

1 of 12 Cured: One Woman's Journey to Remission

Sascha Roth, a 38-year-old woman, first noticed rectal bleeding in 2019. After a biopsy confirmed rectal cancer, she was slated for chemotherapy at Georgetown University. However, a friend's recommendation led her to Memorial Sloan Kettering Cancer Center, where doctors confirmed she had the mutation that poorly responds to chemotherapy, making her eligible for the dostarlimab trial.

Initially preparing for the conventional treatments, Sascha was taken aback when Dr. Cercek revealed the trial results: "We reviewed your scans… There is no trace of cancer."

According to a New York Times article, Sascha Roth remains cancer-free two years after her treatment.

Disclaimer: This article is intended for informational purposes only and should not be considered medical advice. Always consult a healthcare professional for diagnosis or treatment recommendations.

Sources:

Kolata, Gina. "Small Study on Rectal Cancer Results in Remission in Every Patient." The New York Times. 05 June 2022.

Lanese, Nicoletta. "Experimental rectal cancer drug caused all patients' tumors to disappear in small trial." LiveScience.com. 06 June 2022.

Cercek, Andrea, et al. "PD-1 Blockade in Mismatch Repair — Deficient, Locally Advanced Rectal Cancer." The New England Journal of Medicine. 05 June 2022.

"Rectal Cancer Disappears After Experimental Use of Immunotherapy." Memorial Sloan Kettering Cancer Center. 05 June 2022.

Chapter 2: Videos Highlighting the Breakthrough

In this video, explore the implications of a groundbreaking trial involving a new drug for rectal cancer and its potential impact on patients.

This video discusses the promising outcomes of a recent cancer trial, showcasing the success achieved by the participants.