A star is born.
The sequencing of chemotherapy, radiation, and surgery has been forefront in recent trials for locally advanced rectal cancer. But what if some patients need none of those? In this phase 2 trial, patients with stage II or III rectal adenocarcinoma that was mismatch repair deficient—the case for about 5-10% of all rectal tumors—received 6 months of neoadjuvant, single-agent dostarlimab, a PD-1 inhibitor, followed by planned standard chemoradiation and surgery. Here’s the kicker, those with a complete clinical response to dostarlimab continued with clinical observation without either chemoradiation or surgery…which happened in 12/12 patients with >6 months follow-up. Cue this New York Times headline. While a tiny study, it’s created understandable excitement surrounding the fact all 12 (100%) had no evidence of disease confirmed with MRI, PET, endoscopy, and biopsy with no need for scalpel, therapeutic rays nor cytotoxic chemo. | Cercek, N Engl J Med 2022