Dostarlimab belongs to a class of drugs called PD-1 inhibitors that use your own immune system to treat cancer (immunotherapy). It is designed to stop cancer from growing by helping your immune system recognize and fight the cancer. This investigational medicinal product (IMP) has been approved by the Belgian authorities, but not for the treatment of colon cancer.
It is known that a small number of patients with pMMR/MSS colon cancer may have significant response to medication of this type (immunotherapy) depending on each person's biology.
Trial intervention for all patients will be neo-adjuvant dostarlimab 500 mg IV, given alone by intravenous infusion. Two administrations of dostarlimab are foreseen, at three weeks interval, before surgery for your colon cancer. It has not yet been proven that this treatment can cure, improve or stabilise your disease or condition.
The study aims to investigate specific molecular changes in tumour and blood after dostarlimab monotherapy administered and before surgery which could be associated with improved response to conventional treatment in some patients. If you decide to participate, as the duration of treatment with dostarlimab is 6 weeks, surgery may be slightly delayed compared to patients that are not treated with dostarlimab and go directly for surgery. It remains uncertain if this is beneficial in your personal situation but some patients might experience significant response. The risks have been carefully assessed and the potential benefits for some patients are considered important and justify undertaking the treatment.
Subsequent therapy after surgery remains at the discretion of the treating physician.
The duration of a patient on trial will last up to 4 months from the first dose of dostarlimab and afterwards 2 years of follow up is applicable.
at least 18 years of age and capable of giving informed consent
primary adenocarcinoma colon cancer than can be removed surgically, staged cT3-4, cN0-2, cM0 or stage III
tumour expresses an MMR proficient/microsatellite stable called MSS
tissue samples from tumour and colon mucosa available for molecular analyses
no prior cancer treatment
not pregnant and using effective contraception if applicable
Single group
Dostarlimab
DrugDostarlimab \[Jemperli GlaxoSmithKline (GSK)\] is a humanized IgG4 monoclonal antibody that binds with high affinity and specificity to PD-1, resulting in inhibition of binding to PD-L1 and PD-L2. Dostarlimab is in clinical development for the treatment of subjects with solid tumors, including those with recurrent/advanced dMMR/MSI-H solid tumors who have progressed on standard of care chemotherapy, as monotherapy or in combination with other agents.
Multi-omic exploration
Data generation through multi-omic exploration of blood and tissue derived products (see Sampling and Lab manual). Correlation of molecular-biological features identified with pathological response. The presence or absence of specific molecular characteristics in blood and tissue will be correlated in each patient with the degree of tumour response to therapy evaluated by a pathologist.
Safety analysis
Safety analysis. Frequency and severity of treatment emergent AEs, SAEs, irAEs. AEs leading to death, discontinuation of trial intervention or resulting in the participant not being suitable for surgery.
Pathological response
Proportion of participants with pathological response, determined by local assessment.
Survival
Survival time defined from Superhero ICF signature to death from any cause. Proportion of survivors at 2 years. Event free survival time (EFS) defined from Superhero ICF signature to recurrence evaluated by local assessment or death.
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