Maureen Sideris was leading Maine for a wedding when she realized that she couldn’t swallow the sandwich she was lunch.
The 71 -year -old man was soon diagnosed with gastroesophageal cancer. It was August 2022. The tumor, he said, blocked a portion of its esophagus, the tube that transports food from the stomach, which makes food difficult.
The standard treatment approach to esophagus cancer (chemotherapy and radiation, followed by surgery to eliminate part of the esophagus and stomach) “is quite devastating,” said Dr. Luis Díaz, head of solid tumor oncology at the Sloan Kettering MEMORIAL Cancer Center in New York City. “One can overcome that, and there is a new normality after that, but it’s not like what was before.”
When going through all those treatments, Sideris said: “It would have been horrible.”
Instead, he received only one treatment, immunotherapy, as part of a clinical trial in Memorial Sloan Kettering. Two years have passed since he completed his treatment and is in remission.
Díaz, the principal researcher in clinical trials, said that when the first person in the essay responded to immunotherapy, he was exciting.
“You can say: ‘Hey, you ended. You don’t need chemotherapy, radiation or surgery,” Díaz said.
The approach will not work for everyone. Phase 2 test focused on people whose tumors had what is known as mismatch repair deficiency, a mutation that means that DNA errors are not solved when cancer cells are replicated. This leads to even more mutations.
For the treatment to work, “Tumors need to have this mutation,” said Dr. Andrea Cercek of Memorial Sloan Kettering. Cercek directed the clinical trial and presented the findings at the annual meeting of the American Association for Cancer Research on Sunday in Chicago. The investigation was published simultaneously in the New England Journal of Medicine.
The mismatch repair deficiency occurs more frequently in some types of cancer than in others. About 16% of ovarian cancers and up to 30% of endometrial cancers have the mutation, compared to 10% -20% of colorectal cancers. Between 8% and 22% of non -metastatic gastroesophagic cancers are deficient in mismatch.
Immunotherapy medications work teaching a person’s immune system to recognize and attack cancer cells. It has been found that medications work particularly well against tumors with mismatch repair deficiencies, because many mutations provide more objectives for immune cells.
However, drugs are generally not used as a first -line treatment for these types of cancer. On the other hand, they are brought if approaches such as chemotherapy and radiation do not work, or if a cancer returns or has already spread.
The new essay expanded in a smaller Cercek study that used the Dostarlimab immunotherapy medication as the first treatment in 12 people with rectal cancers that advanced but had not spread in other parts of the body. All people’s tumors had mismatch repair deficiencies. Everyone underwent an immunotherapy treatment for at least six months. At the end of that time, the 12 had a complete response, which means that there was no evidence of the remaining tumor. None of them had to undergo other cancer treatments that would generally be used to treat this type of cancer, including surgery.
The researchers began with rectal cancers because treatments, and in particular surgery, can change life. Surgery may involve eliminating the rectum: the final part of the large intestine before the anus. Patients who undergo this surgery should have a colostomy, an operation where the intestine is redirected to a hole made in the abdomen so that the feces are passed out of the body to what is known as an ostomy bag. “This will have a significant impact on your quality of life,” Díaz said.
The second part of the essay extended the treatment to more people, including patients with other cancers who know that they have deficiencies to repair mismatch, including the cancers of the esophagus; endometrium; kidney and ureters; and liver ducts, gallbladder and biliary. All those who registered in the essay had an initial stage cancer, which means that it had not extended to other organs.
Sideris was one of the first people with non -net -nour chance that will be eliminated for treatment in the trial.
During his first appointment, Sideris connected to an IV that dripped immunotherapy in his bloodstream. “In 45 minutes, it’s done,” he said.
Sideris repeated the process every three weeks over the next six months when Cercek and his team registered other people who had recently been diagnosed with cancer. They divided into two categories: those with colorectal cancers and those with the other types.
The first group, the rectal cancers, included 49 patients who completed six months of immunotherapy. They all responded to therapy and did not need surgery, chemotherapy or radiation. About 75% of them were still free of cancer a year or more after completing the treatment.
In the second group, 54 people completed the treatment of six months, and 35, around 61%, had complete answers and did not need to undergo additional treatment. The researchers did not analyze data on the results of 12 months of the patients.
Sideris said she is grateful not to have to endure the side effects of chemotherapy, but immunotherapy caused renal failure, a known side effect of the medication. Now you are taking medications to manage the condition.
Even so, Sideris said: “It was like winning the lottery.”
Dr. Suneel Kamath, a gastrointestinal medical oncologist at the Cleveland Clinic, warned that mismatch repair deficiencies only represent “1% -2% of the cancers at most.”
“Unfortunately, this will not be something that is a cure,” he said.
But for people who have this type of cancer, the findings offer substantial hope: cancer surgery can often be “alterator of life,” Kamath said. “It is possible that a large number does not need surgery at all and can only be cured with immunotherapy.”
Díaz said that for patients with mismatch repair deficiency, it may be possible to avoid 80% of surgeries.
Being able to preserve people’s organs avoiding surgery can have a great effect on the quality of life. Depending on surgery, patients could experience sexual dysfunction, loss of intestinal control, acid reflux and infertility. Chemotherapy and radiation can also damage fertility. This is particularly important at a time when younger are being diagnosed with cancer, Cercek said.
Research also suggests that immunotherapy could be used as a first -line treatment for deficient cancers in early mismatch.
“Immune therapies have a lot of potential. This shows that we could start with that,” said Dr. Heather Yeo, Weill Cornell Medicine Surgical oncologist in New York City.
Díaz said that while larger studies are needed to confirm the findings of the trial, the use of immunotherapy instead of surgery, radiation and chemotherapy may not be very far for certain patients.
“I think it is a short step of this report to the application of the care standard,” he said.
