Immunotherapy is highly effective in some solid tumors
May 14, 2025
Summary: For a small portion of people with certain solid tumors, low-toxicity immunotherapy could outperform surgery, radiation and chemotherapy.
Source: Cercek, et al, New England Journal of Medicine April 27, 2025
Certain types of cancer, including pancreatic and rectal cancer, are rarely found when they are curable and require intensive and invasive treatment, including surgery, radiation therapy, and chemotherapy. Two to three percent of people have solid tumors with a specific genetic mutation (mismatch repair mutation) that makes their cancer susceptible to treatment with immunotherapy. Researchers have now shown that immunotherapy drugs can lead to disappearance of these cancers with this mutation, allowing some patients to avoid intensive conventional therapy.
Researchers gave nine intravenous doses of the immunotherapy drug dostarlimab over six months to 117 patients with a variety of tumors that had this genetic mutation and found that after five years not a single person with rectal or hepatobiliary cancer had any evidence of disease. Some with other cancers (including esophageal, prostate, and urinary) had evidence of disease, but all were able to proceed to conventional therapy. The investigators did cell-free DNA tests, as well as other direct and radiologic imaging, to determine if there was residual disease.
Implications for employers:
Some people with cancers which previously had a poor prognosis will be eligible for immunotherapy treatment, which causes much less disability, and likely leads to longer survivals than conventional surgical, radiation, and medical treatments.
The cost of these immunotherapy drugs is high, and many are given for life.
Some immunotherapy drugs are taken orally and covered through the pharmacy benefit, so patient out-of-pocket costs can be high.
Since these expensive drugs only work for people with specific tumor mutations, health plans should provide coverage for genetic testing of tumors to determine the best treatment. Employers can check with their carrier to be sure that such testing is covered when medically necessary.
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