A promising study on rectal cancer

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Hanna K. Sanoff, MD, MPH, of UNC Lineberger Comprehensive Cancer Center, is the author of Viewpoint in the New England Journal of Medicine which offers a perspective on the evolution of the treatment of rectal cancer. It offers prospects for future treatment of the disease in light of the encouraging results of a study published in the journal which found that the immunotherapeutic drug dostarlimab was particularly effective in a phase II clinical trial on a dozen patients with a subtype of rectal cancer.

Approximately 5-10% of rectal cancers are molecularly characterized as being deficient in mismatch repair enzymes (dMMR). These cancers tend to be less responsive to chemotherapy and radiation therapy, increasing the risk that surgical treatment will be needed. Unfortunately, surgery can lead to significant health consequences, including nerve damage, infertility, and bowel and sexual dysfunction.

“More than 45,000 people in the United States were diagnosed with rectal cancer last year, and many of those cases were in people under the age of 65. Historical treatment for the disease has included radiation therapy, surgery and chemotherapy, which can be debilitating despite its curative potential, highlighting the need for better and more effective treatments that can extend longevity while maintaining quality of life,” said Sanoff, Quality and innovation at North Carolina Cancer Hospital and a professor in the UNC School of Medicine’s Division of Oncology. “These early results of remarkable benefit from the use of dostarlimab are very encouraging but should also be viewed with caution. until the results can be replicated in a larger, more diverse population.”

Sanoff also cautioned that little is known about the duration of the drug’s benefits or its long-term curative nature. Patients in this trial have only been observed for six months to two years so far.

“The responses of these first 12 of the 30 patients planned in the trial were remarkable and exceeded what we expected with standard chemotherapy plus radiation therapy,” Sanoff said. “Although quality of life measures have yet to be reported, it is encouraging that some of the more difficult symptoms, such as pain and bleeding, all resolved with the use of dostarlimab.”

Sanoff noted that there are other immunotherapy drugs that could also be tested against this form of rectal cancer. “As a gastrointestinal medical oncologist, I can’t think of anything better for my patients than to be able to offer them a drug that is more effective, less toxic and that avoids surgery, chemotherapy and radiotherapy; that day can’t come soon enough. ” she says.

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Materials provided by UNC Lineberger Comprehensive Cancer Center. Note: Content may be edited for style and length.

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