NBC News
Maureen Sideris drove towards Maine to attend a wedding when she realized that she could not swallow the sandwich she was eating.
Soon he was diagnosed with gastroesophageal cancer. It was August 2022. He affirms that the tumor blocked a part of its esophagus, the conduit that carries the food from the mouth to the stomach, hindering food swallowing.
The standard treatment of esophagus cancer – quimiotherapy and radiotherapy, followed by surgery to remove part of the esophagus and stomach – “is quite devastating,” says Luis Díaz, head of Oncology of solid tumors of the Sloan Kettering Cancer Center Memorial of New York. “One can overcome it, and then there is a new normality, but it is not as before.”
Going through all those treatments, Sideris said, “it would have been horrible.”
Instead, he only received a treatment -Inotherapy- as part of a clinical trial in the Sloan Kettering memorial. Two years ago the treatment ended and is in remission.
Díaz, principal researcher of clinical trials, said that when the first person in the essay responded to immunotherapy, it was exciting.
“You can say: ‘Hey, you’ve finished. You don’t need chemotherapy, radiotherapy or surgery,” said Díaz.
The approach will not work for everyone. Phase 2 test focused on people whose tumors presented what is known as erroneous pairing repair deficiency, a mutation that means that DNA errors are not corrected when cancer cells are replicated. This causes even more mutations.
For the treatment to work, “tumors must have this mutation,” says Andrea Cercek, of the Sloan Kettering memorial. Cercek who directed the clinical trial and presented the results at the annual meeting of the American Association for Cancer Research, held on Sunday in Chicago. The investigation was published simultaneously in The New England Journal of Medicine.
The deficiency in the repair of mismatches is more frequent in some types of cancer than in others. About 16% of ovarian cancers and up to 30% of endometrium have the mutation, compared to 10% -20% of colorectal cancers. Between 8% and 22% of non -metastatic gastroesophageal cancers are poorly deficient in the repair of erroneous matches.
Immunotherapy drugs teach the immune system to recognize and attack cancer cells. It has been proven that these drugs They work especially well against tumors with deficiencies in the repair of erroneous matchessince the numerous mutations provide more targets for immune cells.
However, these drugs are not usually used as a frontline treatment for these types of cancer. Instead, they are used when chemotherapy and radiotherapy do not work or when cancer reappears or has already spread.
The investigation is based on a smaller Cercek study in which the Dostarlimab immunotherapeutic drug was used as the first treatment in 12 patients with advanced rectum cancer but not disseminated. All tumors had deficiencies in the repair of erroneous matches. All received immunotherapy treatment for at least six months. After that time, the 12 presented a complete response, which means that there was no trace of the tumor. None of them had to undergo other cancer treatments that are usually used to treat these types of cancer, including surgery.
The researchers began with rectal cancers because treatments, and in particular surgery, can change life. Surgery may imply the removal of the rectum, the final portion of the large intestine before the anus. Patients who undergo this surgery should undergo a colostomy, an operation in which the intestine deviates towards a hole practiced in the abdomen so that the feces leave 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 in the repair of erroneous matches, such as esophageal cancers, endometrium, kidney and ureters, and liver, gallbladder and bile ducts. All trial participants suffered from initial stage cancer, that is, it had not extended to other organs.
Sideris was one of the first people with non -colortal cancer authorized to receive treatment in the essay.
In his first appointment, Sideris was connected to an intravenous route that injected immunotherapy into the bloodstream. “In less than 45 minutes, I was already done,” he said.
Sideris repeated the process every three weeks during the next six months, while Cercek and his team enrolled other people who had recently diagnosed cancer. They divided them into two categories: those that had colorectal cancer and those suffering from other types.
The first group, that of rectal cancers, included 49 patients who completed six months of immunotherapy. Everyone responded to therapy and did not need surgery, chemotherapy or radiotherapy. About 75% of them were still free from cancer One 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 more treatment. The researchers did not analyze the data on the results of the patients at 12 months.
Sideris thanked not having to suffer the side effects of chemotherapy, but immunotherapy caused adrenal insufficiency, a well -known secondary effect of the drug. Now take medication to treat it.
However, “it was like winning the lottery,” said Sideris,
Suneel Kamath, a gastrointestinal medical oncologist at the Cleveland Clinic, warned that deficiencies in the repair of erroneous matches only represent “1% -2% of the cancers at most.”
“Unfortunately, this is not going to be something that cures everything,” he said.
But for people who suffer from this type of cancer, findings offer high hopes: cancer surgery can “change life,” Kamath said. “A large number may not need surgery at all and heal only with immunotherapy.”
Díaz said that, in the case of patients with misunderstanding pairing pairing, 80% of surgical interventions.
Being able to preserve people’s organs avoiding surgery can have a huge effect on the quality of life. Depending on surgical intervention, patients may suffer from sexual dysfunction, loss of intestinal control, acid reflux and infertility. Chemotherapy and radiotherapy can also harm fertility. This is especially important at a time when cancer is diagnosed with younger, Cercek said.
Research also suggests that immunotherapy It could be used as first -line treatment For poor cancers in the repair of erroneous matches in early stages.
“Immunotherapies have enormous potential. This shows that we could start around,” said Heather Yeo, Wheill Cornell Medicine surgeon in New York.
Díaz said that, although broader studies are needed to confirm the results of the trial, the use of immunotherapy instead of surgery, radiotherapy and chemotherapy may not be far away for certain patients.
“I think that from this report to the application of standard treatment there is a short step,” he said.
