19 mei 2023: Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij darmkanker samengesteld door arts-bioloog drs. Engelbert Valstar.

19 mei 2023: Bron: June 23, 2022 N Engl J Med 2022; 386:2363-2376

Uit een prospectieve fase 2-studie blijkt uit een eerste evaluatie dat immuuntherapie met dostarlimab, een anti-PD-1 monoklonaal antilichaam (checkpointremmer), vooraf aan operatie toegediend in 6 kuren van 3 weken bij patiënten met operabele maar lokaal uitgezaaide rectumkanker (stadium II of III) met een dMMR = mismatch repair-deficiëntie heel effectief was bij de eerste 12 patiënten. Alle 12 patiënten hadden een complete remissie aan het eind van de dostarlimab behandeling. En alle 12 patiënten hadden een half jaar later na beeindiging van de dostarlimab behandeling nog steeds geen recidief of operatie nodig gehad. Wat betekent dat alle patiënten hun eerder bereikte complete remissie hadden behouden. 

Normaal gesproken in een standaardbehandeling zouden deze patiënten met rectumkanker na een pre-operatieve behandeling geopereerd worden gevolgd door standaard chemoradiotherapie en chirurgie. Maar in het nieuwe studieprotocol staat beschreven dat patiënten die een klinische complete respons hadden (met PET-scan bevestigd) na voltooiing van de dostarlimab behandeling, verder zouden gaan zonder chemoradiotherapie en chirurgie.
Met als belangrijkste doel te kijken of een aanhoudende klinische complete respons 12 maanden na voltooiing van dostarlimab-therapie of pathologische volledige respons na voltooiing van de dostarlimab behandeling met of zonder chemoradiotherapie en algehele respons op neoadjuvante dostarlimab-therapie met of zonder chemoradiotherapie zou blijven.

Dostarlimab, merknaam Jemperli, is een monoklonaal antilichaam dat wordt gebruikt als antikankermedicijn voor de behandeling van met name endometriumkanker .[5][6] maar wordt inmiddels ook onderzocht in studies bij longkanker, prostaatkanker en melanomen. Dostarlimab is een vorm van een checkpointremmer / anti-PD medicijn (PD-1)-blokkerend monoklonaal antilichaam. [5][6][8]

De meest voorkomende bijwerkingen die in de VS worden gemeld, zijn vermoeidheid / asthenie, misselijkheid, diarree, bloedarmoede en constipatie. Bijkomende bijwerkingen die in de Europese Unie zijn gemeld, zijn onder meer braken, gewrichtspijn, jeuk, huiduitslag, koorts en hypothyreoïdie (lage niveaus van schildklierhormonen). [8]
Dostarlimab werd in april 2021 goedgekeurd voor de behandeling van endometriumkanker in zowel de Verenigde Staten als de Europese Unie.[5][6][8][12]

Op basis van de Garnet-studie kreeg dostarlimab versnelde goedkeuring van de Amerikaanse Food and Drug Administration (FDA) in april 2021,[6] en volledige goedkeuring in februari 2023.[7]

Interessant is ook deze reviewstudie over lopende studies met dostarlimab en hoe deze vorm van immuuntherapie juist zo goed werkt bij vormen van kanker met dMMR (mismatch-repair-deficientie. 

Promise of dostarlimab in cancer therapy: Advancements and cross-talk considerations

Met als inhoud (abstract onderaan artikel):

•Een systematische review over overspraak van dostarlimab met adaptieve immuniteit en de klinische onderzoeken ervan, waarvan nu wordt bewezen dat ze een doorbraak zijn.
•Recente ontwikkelingen in verstoring van adaptieve immuniteitsdoelen bij kanker.
•Klinische vooruitgang van door dostarlimab aangedreven moleculaire benadering om kanker te genezen.
•Cross-talk van dostarlimab met adaptieve immuniteit voor een betere respons op de behandeling.

De studie met de rectumkankerpatiënten is gratis in te zien. Klik op de titel van het abstract:

June 23, 2022
N Engl J Med 2022; 386:2363-2376
DOI: 10.1056/NEJMoa2201445

PD-1 Blockade in Mismatch Repair–Deficient, Locally Advanced Rectal Cancer

List of authors.
  • Andrea Cercek, M.D., 
  • Melissa Lumish, M.D., 
  • Jenna Sinopoli, N.P., 
  • Jill Weiss, B.A., 
  • Jinru Shia, M.D., 
  • Michelle Lamendola-Essel, D.H.Sc., 
  • Imane H. El Dika, M.D., 
  • Neil Segal, M.D., 
  • Marina Shcherba, M.D., 
  • Ryan Sugarman, M.D., Ph.D., 
  • Zsofia Stadler, M.D., 
  • Rona Yaeger, M.D., 

Abstract

BACKGROUND

Neoadjuvant chemotherapy and radiation followed by surgical resection of the rectum is a standard treatment for locally advanced rectal cancer. A subset of rectal cancer is caused by a deficiency in mismatch repair. Because mismatch repair–deficient colorectal cancer is responsive to programmed death 1 (PD-1) blockade in the context of metastatic disease, it was hypothesized that checkpoint blockade could be effective in patients with mismatch repair–deficient, locally advanced rectal cancer.

METHODS

We initiated a prospective phase 2 study in which single-agent dostarlimab, an anti–PD-1 monoclonal antibody, was administered every 3 weeks for 6 months in patients with mismatch repair–deficient stage II or III rectal adenocarcinoma. This treatment was to be followed by standard chemoradiotherapy and surgery. Patients who had a clinical complete response after completion of dostarlimab therapy would proceed without chemoradiotherapy and surgery. The primary end points are sustained clinical complete response 12 months after completion of dostarlimab therapy or pathological complete response after completion of dostarlimab therapy with or without chemoradiotherapy and overall response to neoadjuvant dostarlimab therapy with or without chemoradiotherapy.

RESULTS

A total of 12 patients have completed treatment with dostarlimab and have undergone at least 6 months of follow-up. All 12 patients (100%; 95% confidence interval, 74 to 100) had a clinical complete response, with no evidence of tumor on magnetic resonance imaging, 18F-fluorodeoxyglucose–positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. At the time of this report, no patients had received chemoradiotherapy or undergone surgery, and no cases of progression or recurrence had been reported during follow-up (range, 6 to 25 months). No adverse events of grade 3 or higher have been reported.

CONCLUSIONS

Mismatch repair–deficient, locally advanced rectal cancer was highly sensitive to single-agent PD-1 blockade. Longer follow-up is needed to assess the duration of response. (Funded by the Simon and Eve Colin Foundation and others; ClinicalTrials.gov number, NCT04165772. opens in new tab.)

Digital Object ThumbnailQUICK TAKEPD-1 Blockade in Locally Advanced Rectal Cancer 02:15

Supported by the Simon and Eve Colin Foundation, GlaxoSmithKline, Stand Up to Cancer, Swim Across America, and the National Cancer Institute of the National Institutes of Health (awards R21CA252519 and NCI-P30CA008748).

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

This article was published on June 5, 2022, at NEJM.org.

A data sharing statement provided by the authors is available with the full text of this article at NEJM.org.

We thank the participating patients and their families; the study team; and Mary Lynne Hedley, Ph.D., Leon O. (Lonnie) Moulder, Jr., M.B.A., Martin Huber, M.D., and the team at Tesaro (now part of GlaxoSmithKline) for their initial support of this study.

Author Affiliations

From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.).

Dr. Cercek can be contacted at  or at Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065. Dr. Diaz can be contacted at  or at Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065.

Supplementary Material

Research Summary PDF 701KB
Protocol PDF 3035KB
Supplementary Appendix PDF 18006KB
Disclosure Forms PDF 1043KB
Data Sharing Statement PDF 74KB

This article provides a comprehensive overview of dostarlimab, its therapeutic ability, and the different indications for which it is being used. Dostarlimab could serve as a potential alternative to many cancer treatments that frequently have severe consequences on patients’ quality of life.

Post-screen

Promise of dostarlimab in cancer therapy: Advancements and cross-talk considerations

https://doi.org/10.1016/j.drudis.2023.103577Get rights and content
Under a Creative Commons license
open access

Highlights

  • •

    A systematic review on cross-talk of dostarlimab with adaptive immunity and its clinical trials, which are now being proven as breakthrough.

  • •

    Recent developments in disruption of adaptive immunity targets in cancer.

  • •

    Clinical progress of dostarlimab-driven molecular approach to cure cancer.

  • •

    Cross-talk of dostarlimab with adaptive immunity for a better treatment response.

In recent years, immunotherapy for cancer treatment using monoclonal antibodies has shown clinical success, particularly with programmed cell death protein 1 (PD-1) and its ligand programmed death-ligand 1 (PD-L1). Dostarlimab, an immune checkpoint inhibitor, interacts with adaptive immunity by binding to human PD-1, inhibiting PD-L1 and PD-L2 interactions, and cross-talk with adaptive immunity. Recent clinical trials have shown that dostarlimab is effective in treating mismatch repair deficiency (dMMR) in endometrial cancer patients, leading to its approval in the United States and the European Union in 2021. This article provides a comprehensive overview of dostarlimab, its therapeutic ability, and the different indications for which it is being used. Dostarlimab could serve as a potential alternative to many cancer treatments that frequently have severe consequences on patients’ quality of life.

Breakthrough and advancement in a clinical trial of dostarlimab

Dostarlimab was recently tested as a single neoadjuvant treatment for CRC in an open-label clinical investigation of phase 2 as shown in Table 1. The experimental trial included dMMR-positive stage 2 or 3 CRC patients.26 A clinical trial demonstrated the first-ever complete elimination of tumors with no regrowth of malignant cells. Complete eradication of the locally advanced tumor was reported in 12/12 individuals.

Table 1. Major clinical trials of dostarlimab (adapted from https://clinicaltrials.gov/).

Combination therapyNCT numberCancer typePhaseStatus
Bevacizumab, carboplatin, cobolimab, dostarlimab, niraparib, paclitaxel, pemetrexed NCT03307785 Solid tumor, NSCLC Phase I Active, not recruiting
Encelimab, dostarlimab NCT03250832 Solid tumors, colorectal
Bintrafusp alfa, cobolimab, dostarlimab, feladilimab, GSK 3174998, pembrolizumab NCT02723955 Solid tumors
Niraparib, dostarlimab NCT04544995 Recruiting
GSK 6097608, dostarlimab NCT04446351
Dostarlimab NCT03955978 Endometrial
Cobolimab, nivolumab, dostarlimab NCT02817633 Solid tumors
Dostarlimab NCT02715284
Dostarlimab, belantamab NCT04126200 Multiple myeloma Phase II/II Recruiting
Niraparib, pembrolizumab NCT03308942 SCC, NSCLC Phase II Completed
Dostarlimab NCT04774419 Endometrial Recruiting
Dostarlimab NCT04165772 Rectal
Dostarlimab NCT03833479 Cervical
Niraparib, dostarlimab NCT04681469 SCC, head and neck
NCT04701307 Neuroendocrine
NCT04493060 Adenocarcinoma, pancreatic
NCT04584255 BRCA-mutated breast cancer
NCT04313504 Head and neck SCC
NCT04068753 Cervix
NCT03654833 Mesothelioma
Dostarlimab, cobolimab NCT04139902 Melanoma
NCT03680508 Liver
Cobolimab, feladilimab NCT03739710 NSCLC
Paclitaxel, encequidar, dostarlimab NCT01042379 Breast
Niraparib, dostarlimab NCT04409002 Pancreatic Active, not recruiting
NCT03016338 Endometrial
Pembrolizumab, dostarlimab NCT04581824 NSCLC
Niraparib, dostarlimab NCT03955471 Fallopian tube, peritoneal, ovarian Terminated
NCT03651206 Ovarian, endometrial Phase II/III Recruiting
Cobolimab, docetaxel, dostarlimab NCT04655976 NSCLC
Dostralimab. niraparib, doxorubicin, paclitaxel, gemcitabine, topotecan, bevacizumab NCT04679064 Fallopian tube, peritoneal, ovarian Phase III Recruiting
Carboplatin, paclitaxel, dostarlimab NCT03981796 Endometrial Active, not recruiting

Abbreviations: NSCLC, non-small cell lung cancer; SCC, squamous cell carcinoma.

Future perspectives

Due to its breakthrough in cancer, dostarlimab has gained much attention. It needs to be tested in further cancer types by optimizing the dose amount accordingly. This drug can also combined with other therapy to deal with drug resistance in cancer. Importance should be given to reducing the side effects of the drug,which are varied and are not yet been able to be pinpointed to a specific mechanism of action. This understanding can lead to dostarlimab to become a more safe and highly efficient drug for cancer.

Acknowledgments

N.D.T. acknowledges funding under the Science Foundation Ireland and Irish Research Council (SFI-IRC) pathway program (21/PATH-S/9634).

Declaration of interests

No interests are declared.

Data availability

No data was used for the research described in the article.

References

Cited by (0)

© 2023 The Author(s). Published by Elsevier Ltd.

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rectumkanker, immuuntherapie, checkpointremmer, anti-PD medicijn, complete remissie, dostarlimab


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