The Biggest News at ASCO (It's Not About Lymphoma)

More from the ASCO conference:

Based on how many people outside the cancer community are talking about it, the biggest news at ASCO is this presentation with a not-very-exciting-title: "Single agent PD-1 blockade as curative-intent treatment in mismatch repair deficient locally advanced rectal cancer."

This is about a stage 2 clinical trial for a monoclonal antibody for rectal cancer, not Follicular Lymphoma (or any other blood cancer). But it has some lessons, big and small, for those of us with other cancers.

The treatment is called "Dostarlimab," and if you search for it online, you'll find all kinds of headlines in non-medical publications that do things like ask if this is a cure for cancer. The results of the trial are exciting -- 100% Complete Response in every patient in the trial, with no serious side effects. One of the few that keeps its excitement in check is from NPR, with the title "This experimental drug could change the field of cancer research." Still maybe a little too ahead of itself, but at least it says "could" and leaves some room for doubt.

Dostarlimab is a monochlonal antibody (like our old pal Rituxan). There are many, many monochlonal antibodies out there, and they do different things. Dostarlimab is an inhibitor, which means it doesn't attack cancer cells directly, like traditional chemotherapy. Instead, it inhibits, or stops, a process from happening, and when that process stops, the cancer cell has a hard time growing or staying alive. 

In the case of Dostarlimab, it is a PD-1 inhibitor. PD stands for "programmed death." Normal cells have a life span built in to them. Some cells last a long time (like nerve cells), which others die off quickly (like skin cells). It's kind of built in to the cell to have a "programmed death." The process that is supposed to make this happen gets messed up, and you get cancer (cells that won't die). A PD-1 inhibitor is designed to stop that messed up process and allow cells to die.  

The results presented at ASCO were pretty remarkable. The 14 patients in the trial had a 100% Complete Response -- the cancer disappeared for all of them -- and no severe (grade 3 or higher) side effects (usually, at least 10% of patients in a trial like this will have severe side effects).

The early results mean that standard treatment for rectal cancer, including surgery and radiation, followed by chemotherapy, could be a thing of the past. 

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So what are the lessons to be learned?

Well, first, as we all know, a 14 patient trial is tiny. The more patients in a trial, the more likelihood that those unheard-of results will even out. One of the things I like about the NPR reporting that I linked above is that it is mostly an interview with an oncologist who wasn't part of the study, who has an optimistic but realistic view of it. She expects that the 100% CR will go down in a phase 3 trial. There might still be excellent results, but probably not 100% (though it would be wonderful if there was that high a rate). Also, there is a 6 month follow up for the study, so it's possible that after some time, the treatment stops working. (Again, it would be wonderful if that wasn't the case.) It's also possible that, with a larger trial with more patients, some more severe side effects showed up. (Or maybe not.)

So the main lesson in all of this is, stay optimistic, but cautious. I think after 14 years, I've learned how to maintain that balance. I'm always hopeful, but I also know that things don't always work out when they are tested more.

But the other big lesson for us, as Follicular Lymphoma patients, is that Immunotherapy still holds lots of promise for us. There aren't a lot of new chemotherapies being developed (if any), because researchers are learning more and more about how genes affect cancer, and how the immune system can be manipulated in ways that make treatments effective. 

But all of that takes time. We've seen recently that another type of inhibitor can have issues for FL patients. Maybe a PD-1 Inhibitor will do the job, either by itself or in combination. (This article from about a year ago looks at all of the different Immunotherapies being researched for FL, including two well-known PD-1 inhibitors, Keytruda and Opdivo, that have been very successful in some other cancers.)

And that's probably the biggest lesson of all -- these things take time. The development of cancer treatments is a slow process, usually resulting in small steps forward. Maybe Dostarlimab will make a huge difference for the small group of rectal cancer patients that it helps. I hope so. And maybe then, FL researchers will find something in it that might lead to a new treatment for FL. But, again, that will take time. 

The best thing we can do (beyond hoping and praying)? Talk to your oncologist about clinical trials. The patients in the Dostarlimab trial decided to take a chance, not go through traditional treatments, and try something new. Talk to your oncologist about whether a trial might work well for you. It will help out all of us.

More ASCO news next time.