An experimental cancer drug appears to have cured every single patient in a small clinical trial conducted in the US.
All 12 patients, who had been diagnosed with rectal cancer, entered into remission after taking dostarlimab for over six months, according to a study published in the New England Journal of Medicine.
Mismatch Repair–Deficient (dMMR) Tumors
Indicated for adults with mismatch repair–deficient (dMMR) recurrent or advanced endometrial cancer that has progressed on or following a prior platinum-containing regimen
Also indicated for adults with dMMR recurrent or advanced solid tumours who have progressed on or following previous treatment and have no satisfactory therapeutic options.
Doses 1-4: 500 mg IV q3Weeks, THEN
Dose 5 and thereafter (start 3 weeks after Dose 4): 1,000 mg IV q6Weeks until disease progression or unacceptable toxicity
Dosage Modifications
No dose reductions are recommended
Pneumonitis
- Grade 2: Withhold therapy; resume when complete or partial resolution occurs (Grade <1) after corticosteroid taper
- Permanently discontinue if there is no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of starting steroids.
- Grade 3 or 4 or recurrent Grade 2: Permanently discontinue
Colitis
- Grade 2 or 3: Withhold therapy; resume when complete or partial resolution occurs (Grade <1) after corticosteroid taper
- Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of initiating steroids.
- Grade 4: Permanently discontinue
Hepatitis with no tumor involvement of the liver
- AST or ALT increases to >3 and ≤8x ULN or total bilirubin [TB] increases to >1.5 and <3x ULN: Withhold therapy; resume when complete or partial resolution (Grade <1) occurs after corticosteroid taper
- Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of initiating steroids.
- AST or ALT increases to >8x ULN or TB increases to >3x ULN: Permanently discontinue
Hepatitis with tumour involvement of the liver
Withhold therapy
- Baseline AST or ALT >1 and ≤3x ULN and increases to >5 and ≤10x ULN
- Baseline AST or ALT >3 and ≤5x ULN and increases to >8 and ≤10x ULN
- Resume when complete or partial resolution occurs (Grade <1) after corticosteroid taper
- Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of initiating steroids
Permanently discontinue
- AST or ALT increases >10x ULN or TB increases to >3x ULN
Endocrinopathies
- Grade 2, 3, or 4: Withhold until clinically stable or permanently discontinue depending on the severity
- Permanently discontinue if no complete or partial resolution (Grade <1) within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of starting steroids.
Nephritis with renal dysfunction
- Grade 2 or 3 increased blood creatinine: Withhold therapy; resume when complete or partial resolution occurs (Grade <1) after corticosteroid taper
- Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of starting steroids.
- Grade 4 increased blood creatinine: Permanently discontinue
Exfoliative dermatologic conditions
Suspected Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug rash with eosinophilia and systemic symptoms (DRESS) syndrome: Withhold therapy
Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of initiating steroids.
Confirmed SJS, TEN, or DRESS syndrome: Permanently discontinue
Myocarditis
- Grade 2, 3, or 4: Permanently discontinue
Neurologic toxicities
- Grade 2: Withhold therapy; resume when complete or partial resolution occurs (Grade <1) after corticosteroid taper
- Permanently discontinue if there is no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone ≤10 mg/day (or equivalent) within 12 weeks of initiating steroids.
- Grade 3 or 4: Permanently discontinue
Infusion-related reactions
- Grade 1 or 2: Interrupt or slow infusion rate
- Grade 3 or 4: Permanently discontinue
Renal or hepatic impairment
- Mild-severe and end-stage renal disease: No dosage adjustment necessary
Hepatic impairment
- Mild-to-moderate (TB ≤3x ULN and any AST): No dose adjustment is recommended
- Severe: Not studied
Dosing Considerations
Females of reproductive potential: Verify pregnancy status before initiation
Recurrent or advanced dMMR endometrial cancer or solid tumours
- Select patients based on the presence of dMMR in tumour specimens
- Information on FDA-approved tests is available at: http://www.fda.gov/CompanionDiagnostics
“This is the first time this has happened in the history of cancer”, Dr Luis Diaz, one of the lead authors of the paper, told The New York Times.
The patients also experienced no significant side effects during the course of their treatment.
https://www.independent.co.uk/topic/us -
No comments:
Post a Comment