For what types of cancer is dostarlimab used? The only insight you need.
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Since its first FDA approval in 2021, dostarlimab (commercially sold as Jemperli) has often made headlines. It has even often been called a “miracle drug” or a “cure for cancer”.
Anyone with cancer wishes these headlines were true, and we understand that. However, it is important to stick to the facts.
Below is a simple overview of the different types of cancer treated with dostarlimab, as well as ongoing research in other areas.
What is dostarlimab?
Dostarlimab is the active ingredient in the drug Jemperli. It is a monoclonal antibody that targets the PD-1 protein on cancer cells. This prevents cancer cells from escaping detection by our immune system's T cells. It helps strengthen our immune system's ability to identify and kill cancer cells.
Dostarlimab: Approved treatment for advanced or recurrent primary endometrial cancer.
Jemperli (dostarlimab) was first approved in 2021 as a second-line treatment for recurrent or advanced dMMR endometrial cancer. In 2023, this approval was extended to use in primary endometrial cancer advanced or recurrent dMMR/MSI-H 11.
Dostarlimab is administered in combination with chemotherapy as first-line treatment, and as monotherapy as second-line treatment.
How successful is dostarlimab for endometrial cancer?
In the RUBY clinical trial, Jemperli (dostarlimab) was used with chemotherapy to treat dMMR/MSI-H advanced or recurrent primary endometrial cancer. According to the trial results, 73.8% of patients had a partial or complete response to treatment with chemotherapy. According to the trial results, 73.8% of patients achieved a partial or complete response to treatment with Jemperli and chemotherapy. 61.3% of them continued to report this effect one year after trial.
Used as monotherapy in the second-line treatment of advanced or recurrent dMMR/MSI-H endometrial cancer, Jemperli (dostarlimab) achieved a response rate of 45.4%. 85.9% of patients still reported the effect after one year, and 54.7% after 2 years.
Can dostarlimab be used for colorectal cancer?
Yes, dostarlimab has received FDA approval for use as a second-line treatment in patients with recurrent or advanced dMMR/MSI-H colorectal cancer. The medication is used in cases where the cancer has progressed or has not responded to initial chemotherapy.
Dostarlimab's effectiveness in the treatment of advanced or recurrent dMMR/MSI-H colorectal cancer was evaluated in the GARNET trial. The overall response rate was 36%, with a median response duration of 30.1 months.
dMMR/MSI-H cancers represent only 3 to 5% of all colorectal cancers. However, according to Dr. Mohamedtaki Tejani of the AdventHealth Cancer Institute, they are particularly sensitive to immunotherapy.
Ongoing trials aim to evaluate the possibility of using dostarlimab even earlier in the treatment of dMMR/MSI-H rectal cancers.
Dostarlimab as first-line treatment for dMMR/MSI-H rectal cancer
In a small phase 2 trial, 12 patients with stage 2 or 3 rectal cancer received treatment with dostarlimab every 3 weeks for 6 months. 100% of patients showed a complete response to treatment. During 6 to 25 months of follow-up, no disease progression or recurrence was reported. Additionally, no adverse reactions grade 3 or higher were reported.
If dostarlimab is approved for first-line treatment of dMMR/MSI-H rectal cancer, it could save patients from undergoing unnecessary chemotherapy. Currently, chemotherapy is administered to all patients with stage 2 or 3 rectal cancer, regardless of their MMR status. Still, research indicates that dMMR rectal cancer patients may not benefit from chemotherapy as much as pMMR 16 patients. Furthermore, both groups are equally vulnerable to the side effects of chemotherapy.
Although these results are encouraging, they only come from a single clinical trial. It is important to interpret them with caution. Further studies are needed to validate these first positive results.Can dostarlimab be used for stomach cancer?
Dostarlimab is not currently approved for the treatment of gastric cancer. However, gastric cancer patients participated in the phase 1 GARNET study. Based on the reported results, here are the highlights :- 45.5% of patients with stomach cancer who participated in the study saw their tumor decrease in size or disappear;
- Median progression-free survival was 5.5 months;
- The median overall survival was 20.1 months.
More data is needed to determine the role dostarlimab might play in treating stomach cancer. The GERCOR Phase 2 study and similar ongoing studies aim to gather more information about dostarlimab's effectiveness in treating stomach cancers and potentially support its marketing authorization application. The GERCOR study is expected to be completed at the end of 2028.
Is dostarlimab effective against lung cancer?
Dostarlimab is not currently approved for the treatment of lung cancer. However, it is the subject of studies aimed at evaluating its effectiveness and safety in this area.
PERLA Trial: Jemperli vs Keytruda in Non-Small Cell Lung Cancer (NSCLC)
The PERLA trial compared two PD-1 inhibitors, Jemperli vs Keytruda, in the treatment of metastatic non-squamous non-small cell lung cancer (NSCLC).
Results reported so far show a 46% objective response rate for dostarlimab (Jemperli) with chemotherapy, compared to 37% in the group treated with pembrolizumab (Keytruda). Dostarlimab showed better results for male and female patients, and for patients with or without brain metastases. However, for patients with liver metastases, pembrolizumab achieved a higher objective response rate (43%) than dostarlimab (26%).
The median progression-free survival with dostarlimab was 8.8 months compared to 6.7 months for patients treated with Keytruda .
COSTAR Lung Trial: Dostarlimab Alone or With Chemotherapy in Non-Small Cell Lung Cancer (NSCLC)
The COSTAR Lung trial is another ongoing clinical trial involving dostarlimab in the treatment of advanced non-squamous and squamous NSCLC. The trial focuses on patients whose cancer has progressed after prior treatment with a PD-L1 inhibitor and chemotherapy 7. The trial compares three treatments to each other:- Cobolimab in combination with dostarlimab and docetaxel;
- Dostarlimab in combination with docetaxel;
- Docetaxel monotherapy.
The completion date for the COSTAR trial is set for September 2024. Final results are expected to be available after January 2026.
Can dostarlimab be used for breast cancer?
Yes, dostarlimab has received FDA approval for the treatment of advanced dMMR breast cancer that has progressed after prior treatment and when there are no other options available 17.
However, of all breast cancers, less than 1% present the dMMR biomarker. Can dostarlimab be used to treat the rest of breast cancer patients? Trials are underway to determine this.
Can dostarlimab be used for breast cancer?
Yes, dostarlimab has received FDA approval for the treatment of advanced dMMR breast cancer that has progressed after prior treatment and when there are no other options available.
However, of all breast cancers, less than 1% present the dMMR biomarker. Can dostarlimab be used to treat the rest of breast cancer patients? Trials are underway to determine this.
Dostarlimab in triple-negative breast cancer
The I-SPY2 study is investigating the effectiveness of using dostarlimab in combination with oral paclitaxel and carboplatin in early-stage triple-negative breast cancer. The reported results show a pathologic complete response rate of 48%. According to Dr. Yeung of the University of California, San Diego, this result is lower than expected. Further studies are needed before using this treatment combination in clinical practice.
Another phase 2 clinical trial (NADiR) is studying the combination of dostarlimab, niraparib and radiotherapy as a treatment for metastatic triple-negative breast cancer. The results of this trial are expected by the end of 2029.What other cancers can be treated with dostarlimab?
Immunotherapy drugs like dostarlimab are not limited to specific tumor types. Although the drug is currently approved for the treatment of endometrial cancer and certain dMMR solid tumors, it may apply to other cancers in the future. Hopefully it will also apply to other tumor types besides dMMR.
The wide variety of ongoing clinical trials involving dostarlimab versus Keytruda and other PD-1 inhibitors will provide more data on the drug's future impact on cancer treatment.