{"id":3798,"date":"2022-06-17T18:17:22","date_gmt":"2022-06-17T18:17:22","guid":{"rendered":"https:\/\/seniorfitness.blog\/?p=3798"},"modified":"2022-06-13T18:18:05","modified_gmt":"2022-06-13T18:18:05","slug":"dostarlimab-et-monoklonalt-antistof-til-kraeftbehandling","status":"publish","type":"post","link":"https:\/\/seniorfitness.blog\/?p=3798","title":{"rendered":"Dostarlimab – et monoklonalt antistof til kr\u00e6ftbehandling"},"content":{"rendered":"

Forleden faldt jeg over en artikel p\u00e5 Avisen.dk med den noget opsigtsv\u00e6kkende titel: Mirakelkur mod kr\u00e6ft konstateret<\/em><\/a>, forfattet af Per Kuskner.<\/p>\n

Artiklen refererer til et videnskabeligt studie af l\u00e6gemidlet dostarlimab, hvor resultaterne fra et s\u00e5kaldt fase 2 klinisk studie p\u00e5 patienter med endetarmskr\u00e6ft blev publiceret i The New England Journal of Medicine<\/a>.<\/p>\n

Dostarlimab er et s\u00e5kaldt monoklonalt antistof rettet mod et overfladeprotein p\u00e5 lymfocytter kaldet PD-1 (programmed death protein 1 eller CD279). Dostarlimab fungerer som en s\u00e5kaldt PD-1 inhibitor og kan aktivere immunsystemet s\u00e5 det potentielt kan angribe kr\u00e6ftceller.<\/p>\n

I det n\u00e6vnte studie fandt forskerne, at for 12 ud af 12 patienter med endetarmskr\u00e6ft i stadie II eller III, der modtog 6 m\u00e5neders antistofbehandling var deres kr\u00e6ftknude forsvundet, s\u00e5ledes at det (mindst 6 m\u00e5neder efterf\u00f8lgende) ikke var n\u00f8dvendigt at g\u00e5 videre med kemoterapi.<\/p>\n

We\u2019ve now treated a total of 14 patients, and all\u2014100%\u2014have had a clinical complete response to dostarlimab alone\u2026. No patients have required chemotherapy, radiation, or surgery. There were no grade 3 or 4 events. There have been no disease recurrences observed \u2026 though longer follow-up is certainly required to establish the durability of this treatment. – Andrea Cercek, f\u00f8rsteforfatter p\u00e5 studiet, udtalt p\u00e5 The ASCO Annual Meeting<\/a>.<\/p><\/blockquote>\n

Det lyder som et fantastisk resultat, hvilket ogs\u00e5 har f\u00e5et klinikere til at udtale, at s\u00e5 h\u00f8j effektivitet ift. behandling af endetarmskr\u00e6ft ikke er set f\u00f8r.<\/p>\n

I think everyone in this room will agree that the results are clinically meaningful. The 100% clinical complete response rate is unprecedented in rectal cancer, and the potential to decrease morbidity by eliminating pelvic radiation and surgery for our patients is huge. – Kimmie Ng, Co-Director af Colon and Rectal Cancer Center p\u00e5 Dana-Farber Cancer Institute.<\/p><\/blockquote>\n

Hvis vi vender tilbage til artiklen p\u00e5 Avisen.dk, kunne man godt f\u00e5 det indtryk af at dostarlimab m\u00e5ske er det helt store gennembrud for behandling af kr\u00e6ft i tyk- og endetarm og m\u00e5ske for kr\u00e6ftbehandling i det hele taget. Inden man begynder at t\u00e6nke de tanker, er der lige et par forbehold, som skal p\u00e5 banen.<\/p>\n

Uagtet at det er en imponerende 100% behandlingseffektivitet er det aktuelle studie baseret p\u00e5 behandling af ret f\u00e5 patienter (blot 12 patienter da studiet blev publiceret), og der skal et st\u00f8rre studie med flere patienter til at verificere, at det virkelig holder.<\/p>\n

Dern\u00e6st er det vigtigt at holde sig for \u00f8je, at de patienter som indgik i studiet er blevet n\u00f8je udvalgt. De havde s\u00e5kaldt dMMR (mismatch repair deficient<\/em>) endetarmskr\u00e6ft, hvilket kun udg\u00f8r 5-10% af tilf\u00e6ldende af endetarmskr\u00e6ft. Det er tidligere p\u00e5vist, at netop denne type endetarmskr\u00e6ft kan reagere p\u00e5 s\u00e5kaldte PD-1 inhibitorer, men det er langt fra ensbetydende med, at det samme vil g\u00f8re sig g\u00e6ldende for de resterende 90-95% af tilf\u00e6ldene.<\/p>\n

Og hvad ang\u00e5r andre kr\u00e6ftformer, s\u00e5 er det nok ogs\u00e5 en id\u00e9 at vente lidt med at l\u00f8fte armene for h\u00f8jt i vejret. Dostarlimab behandling af andre kr\u00e6ftformer, med samme mismatch repair deficiency<\/em> som patienterne i det aktuelle studie giver ikke n\u00f8dvendigvis lige s\u00e5 imponerende resultater. I slutningen af 2021 f\u00e6rdigbehandlede Medicinr\u00e5det i Danmark en ans\u00f8gning om brugen af dostarlimab til anvendelse af dMMR livmoderkr\u00e6ft for patienter med tilbagefald. R\u00e5det konkluderede<\/a>, at udover mindre bivirkningsgrad end kemoterapi, s\u00e5 var antistofbehandlingen i de fleste tilf\u00e6lde ikke mere effektiv end traditionel behandling af disse patienter. I andre tilf\u00e6lde var behandlingen marginalt bedre, men ikke s\u00e5 overbevisende, at den kunne anbefales i forhold til udgiften til medicinen. Medicinr\u00e5dets anbefalinger er som altid v\u00e6rd at tage til efterretning, ogs\u00e5 i dette tilf\u00e6lde, hvor prisen p\u00e5 medicinen er skyh\u00f8j (if\u00f8lge Avisen.dk er prisen i USA p\u00e5 $9.000 pr. injektion).<\/p>\n

S\u00e5 ind til videre m\u00e5 konklusionen v\u00e6re, at der sandsynligvis er gode udsigter for behandling af en lille patientgruppe med endetarmskr\u00e6ft, og at det bestemt er v\u00e6rd at forf\u00f8lge om der er potentiale for en lignende virkning p\u00e5 andre kr\u00e6ftformer.<\/p>\n","protected":false},"excerpt":{"rendered":"

Forleden faldt jeg over en artikel p\u00e5 Avisen.dk med den noget opsigtsv\u00e6kkende titel: Mirakelkur mod kr\u00e6ft konstateret, forfattet af Per Kuskner. Artiklen refererer til et […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":3804,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[166],"tags":[597,598],"class_list":["post-3798","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicin","tag-dostarlimab","tag-jemperli"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/seniorfitness.blog\/wp-content\/uploads\/2022\/06\/dost.png?fit=635%2C489&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p8lpEz-Zg","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/posts\/3798","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3798"}],"version-history":[{"count":7,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/posts\/3798\/revisions"}],"predecessor-version":[{"id":3806,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/posts\/3798\/revisions\/3806"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=\/wp\/v2\/media\/3804"}],"wp:attachment":[{"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3798"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3798"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/seniorfitness.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3798"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}