'Tumor just vanished': Facts and hype
After months of bird flu, monkeypox, the never-ending COVID-19 omicron variants, we need great news:
“Small cancer drug trial sees tumors disappear in 100% of the patients,” Washington Post headlined.
“Rectal cancer drug trial of dostarlimab cures all patients,” Fox News.
“Tumor just vanished,” CNN.
You’re excited, I’m excited, but I’m sure at the back of our heads, we’re all thinking: What’s the catch?
Here’s the big happy picture without the hype.
Colorectal cancer is the third most common cancer in the US; about 1 in 25 of us will get it. It’s the second leading cause of cancer death (after lung).
The colon is the last part of our food tract. It’s about 5 feet long, but 1 in 3 cancer occurs in the last few inches of the colon – called rectum.
Usually when rectal cancer invades the surrounding tissues, doctors shrink it first with chemotherapy and radiation, then try to do the rest with surgery.
In this small trial of over a dozen participants, the researchers tried to shrink the rectal cancer first using a new drug, dostarlimab, in the form of 9 infusions over 6 months.
In months, their cancer disappeared. The first participant is cancer-free two years from her last infusion. Nobody needed additional treatment (yet). That was the first great surprise.
Also, the old cancer cocktail of chemo/radiation/surgery has serious side effects, leaving many infertile, incontinent. In this trial, participants had minimal problems.
Yeah! All true, all good.
But: First, this drug works best on certain rectal cancer. About one in 10 fits the profile.
To evade the detection of our immunity, this unique cancer possesses a cloaking surface protein, called checkpoint, to hide its “cancerness.”
Drugs like dostarlimab, checkpoint inhibitors, block the cheating-and-lying protein and expose the cancer cells. Upon recognition, our immunity attacks the cancer.
While dostarlimab may sound novel, neither the idea nor the technology is new. We have 8 other checkpoint inhibitors. The first one was FDA-approved over 10 years ago.
These drugs have been used in treating many cancers, and they’re the subjects of thousands of ongoing cancer trials. They work well. What dostarlimab proved: They work really well in certain cancer.
But firing up our immune system has its drawbacks; checkpoint inhibitors have been known to attack normal tissues.
My take: We’ve already made huge strides in our fight against colorectal cancer. Deaths from colon cancer are half of what they were 50 years ago thanks to better treatment and screening.
Two helpful facts:
1. Currently, experts recommend starting colorectal cancer screening (stool cards, sigmoidoscopy, colonoscopy, or colon CT) at age 45.
2. Colorectal cancer is very sensitive to poor diet, smoking, alcohol, and obesity. A 2010 Denmark study suggests lifestyle changes could reduce our cancer risk by 25%. That’s good news too.
Soon, we could see more dostarlimab-like success. For over a century, we’ve been manipulating our immune system to treat anything from infection to cancer to autoimmune diseases to organ transplants. The oldest and still the best immune helper is vaccine.