Cancer Breakthrough!?

Image a no-surgery and no-chemo approach to cancer treatment that resulted in a 100% rate of remission with no serious adverse side effects. Sounds like a dream, right?

It’s actually happened.

Background: DNA mismatch is a factor in 15% to 29% of all colon cancers and 10% of rectal cancers. This mismatch occurs randomly during normal DNA replication (which is involved in cell creation) as well as due to injury from environmental factors (e.g., pollution). The body has a process for detecting and repairing mismatch errors, as shown in the graphic below. However, for whatever reasons, sometimes that process doesn’t work.

The mismatch can lead to uncontrolled cell growth, which is cancer.

DNA error repair process. The graphic shows an error in duplicating a DNA strand, in which the system identifies the mistakes, cuts out the section of the new strand containing the mistakes, and replaces it.

A clinical trial was designed to test a new drug from Glaxo Smith Kline (GSK) called dostarlimab. Patients were to undergo treatment with the drug, 6 months of followup observation, and 6 months of chemotherapy during this trial. The trial involved researchers from the Memorial Sloan Cancer Center and Yale University, and was underwritten by the Simon and Eve Colin Foundation, GSK, Stand Up to Cancer, Swim Across America and the National Cancer Institute.

Dostarlimab is part of the immunotherapy approach to treatment of cancers. This method involves tagging cancer cells so that the body’s immune system recognizes them as targets and attacks them. The approach, using different drugs, has been highly successful with brain and other cancers, and was first tried for cancers where traditional treatments involved a high risk of collateral damage to the patient. The obvious example is brain surgery, where there is a risk to cognitive function and mobility from an incision into the brain.

However, for the first 12 patients to enter the trial, the cancer was not visible by the end of six months. None needed the chemo portion of the trial. No one had ever seen a perfect score in any cancer trial prior to this.

One of the paper’s authors, Dr. Luis A. Diaz, told The New York Times that he “believes this is the first time this has happened in the history of cancer.” (2)

Obviously, these results require replication in a larger sample of patients. However, the odds of a perfect score are so tiny that unless we can find a flaw in the research, we can accept the value of this drug as fact. If you gave any new drug a 20% chance of causing complete remission — and that would probably be a very generous estimate — the odds of winning 12 times in a row would be 0.0000004096%. You have a better chance of being hit by lightning (0.00653595%).

There already is an effort underway to assemble clinical trials to test the effectiveness of this drug on colon cancer.

It’s nice to have something good to report every once in a while.

Finally, I want to thank Ned Hamson for bringing the Jerusalem Post article to my attention.

Sources:

1. https://www.nejm.org/doi/full/10.1056/NEJMoa2201445
2. https://www.jpost.com/health-and-wellness/article-708816
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348681/
4. https://nedhamsonsecondlineviewofthenews.com/2022/06/07/clinical-trial-sees-rectal-cancer-in-remission-for-all-participants-the-jerusalem-post/