A new drug replaces surgery, chemo in cancer treatment, offers hope to patients
When Maureen Sideris was told she had cancer in 2022, a tumour at the junction of her esophagus and stomach, her first fear wasn't death. It was losing her voice."I was afraid that if I got surgery on my esophagus, I wouldn't be able to talk for a while," she recalled. "That would have been awful."But instead of going under the knife or through the punishing cycles of chemotherapy, Maureen was enrolled in a clinical trial at Memorial Sloan Kettering Cancer Center (MSK) in New York.advertisement
Her treatment? Just six months of immunotherapy, no surgery, no radiation, no chemo.Today, she is cancer-free.Maureen is one of 84 patients whose tumours disappeared entirely after receiving dostarlimab, an immunotherapy drug, in a phase 2 clinical trial.The results, shared at the 2025 Annual Meeting of the American Association for Cancer Research (AACR) and published in the New England Journal of Medicine, could mark a paradigm shift in how certain cancers are treated.The trial, led by gastrointestinal oncologists Dr Andrea Cercek and Dr Luis Diaz Jr. at MSK, enrolled 103 people with early to locally advanced cancers, including rectal, colon, esophageal, liver, urinary, and gynecologic tumours.
84 out of 103 patients had a complete response to the treatment. ()
advertisementAll had something in common: a genetic signature called MMRd, mismatch repair deficiency.This mutation makes tumours more prone to DNA copying errors, but also more visible to the body's immune system, making them ideal targets for checkpoint inhibitors like dostarlimab, sold under the brand name Jemperli.Checkpoint inhibitors work by taking the brakes off the immune system, allowing it to spot and destroy cancer cells that usually hide in plain sight.The most striking results came from the 49 patients with rectal cancer, every single one had a complete response, meaning their tumours disappeared. Among the other 54 patients with cancers in different organs, 35 also experienced total remission.Crucially, 82 of the 84 patients who went into remission were able to avoid surgery altogether."This study shows that immunotherapy can replace surgery, radiation, and chemotherapy for mismatch repair-deficient solid tumors, which could help patients preserve their organs and avoid the harsh side effects of chemo and radiation," said Dr. Cercek.For years, the standard treatment for many solid tumours, especially those in the digestive and reproductive systems, has been a harsh triad: surgery, chemotherapy, and radiation.
The most striking results came from the 49 patients with rectal cancer, every single one had a complete response, meaning their tumours disappeared. ()
While often effective, these approaches come with heavy side effects: pain, fatigue, infertility, incontinence, loss of sexual function, and long recovery periods.What this new trial shows is that for patients with MMRd cancers, there may be another way.To monitor how well the treatment was working, the researchers used an emerging tool called ctDNA testing, short for circulating tumour DNA.This is a type of liquid biopsy, a blood test that detects tiny fragments of tumour DNA in the bloodstream.Using a technology called Haystack MRD, developed by Quest Diagnostics, they were able to detect whether a tumour had disappeared in as little as 1.4 months.This could make future cancer monitoring not only faster but also safer and more accessible. Out of 103, 49 had rectal cancer. Every single one of them (100%) had a complete response, meaning their tumour disappeared after immunotherapy.The remaining 54 patients had other types of cancer (like colon, liver, esophagus, etc.). Of these, 35 saw their cancers disappear - a 65% success rate.advertisementAltogether, 84 out of 103 patients had a complete response to the treatment. Out of those 84 patients who had a complete response, 82 did not need surgery, a big deal, since traditional cancer treatment often involves removing organs or tissue.Most patients with the specific cancer mutation (MMRd) responded incredibly well to immunotherapy alone, with no need for chemo, radiation, or surgery, especially those with rectal cancer.It's important to note that not all cancer patients will benefit from this treatment.But for those who do have this genetic mutation, the trial offers an entirely new path.The results suggest that in the future, the blood test ctDNA could become an important tool to check how well cancer treatments are working, especially when the tumour is in a part of the body that's hard to reach or cannot be easily seen or tested with a biopsy.For Dr. Cercek and Dr. Diaz, the goal is now to expand this approach to even more types of cancer. You May Also Like
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