Dostarlimab's Promise in dMMR Locally Advanced Rectal Cancer

Mark A. Lewis, MD, director of gastrointestinal oncology at Intermountain Health, discusses dostarlimab-gxly (Jemperli), a PD-1 inhibitor and immunotherapy drug, and how experts can best counsel patients with locally advanced mismatch repair-deficient (dMMR) rectal cancer about the potential for long-term disease control with this agent.

Dostarlimab previously showed its potential for the treatment of patients with colorectal cancer with trials demonstrating a 100% complete response rate in this patient population.

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0:09 | It is super promising. I think in the US, we have been slower to adopt what you might call watchful waiting or nonoperative management than say our colleagues in Brazil who I think could have been extremely forward-thinking in this respect. There are just a variety of reasons for that. If I am being honest, I think part of it has been medical-legal. Now that we have this important and pretty famous precedent, well, I will tell you as my patients now for 2 years, have been asking upfront, Dr. Lewis, am I a candidate for immunotherapy?

0:41 | I saw that almost immediately upon my return from [the American Society of Clinical Oncology Annual Meeting] 2022. It understandably persisted since then, because everybody, if they [could] be eligible for it, would prefer nonoperative management. The hard part is that a fraction of our patients are eligible. Certainly, no more than one-fifth, maybe lower than that. There is a little bit of dangling this prospect of not just nonoperative management, but nonchemo[therapy], nonradiation management from the patients and then taking it away. But again, it is important that we ask the question. I love it actually. The patients are so savvy and motivated that they are doing their own research. I mean that praise respectfully, and they are asking that question. But frankly, if the oncologist now is not thinking about that upfront, then we are doing a disservice to the patient.