DOSTARLIMAB - A potential cure for Cancer. A programmed death-1 (PD-1) inhibitor called DOSTARLIMAB has been licensed for the treatment of certain tumors that have advanced during or after prior therapy and do not have any promising alternative choices. Dostarlimab has also demonstrated encouraging outcomes in the treatment of breast cancer, melanoma, head and neck cancer, endometrial cancer, and ovarian cancer. Dostarlimab, a monoclonal antibody against the programmed cell death protein (PD-1) that has been shown to completely (100%) cure patients with colorectal cancer, has enchanted the medical community in this period of rapid advancement. Also, none of the study participants experienced any significant negative effects, according to the findings of clinical trials. • Dostarlimab slows the growth of tumors and boosts the immune system's ability to combat cancer cells.

1. ZOHA SHAIK
PHARM-D
MRM COLLEGE OF
PHARMACY.

2. Abstract
Introduction
Mechanism of Action
Pharmacology and Efficacy
Adverse Effects
Clinical Trials
Treatment

3. ABSTRACT:
 A programmeddeath-1(PD-1)inhibitorcalled DOSTARLIMABhasbeen licensed for
the treatmentof certaintumorsthat haveadvancedduringor after priortherapy and
do not haveanypromisingalternativechoices.
 Basedon the rateof tumor response andlength of the response, asestablished by
the FDA-authorizedtest, this indicationwasquicklyapproved.
 On June 6th, 2022,a tiny study withunexpected findingsabout the effectiveness of a
novel immunotherapy treatmentagainstrecurrentcancer waspublished.
 In everypatientwho receivedthe medication,remissionwas broughton. They were
all administeredDOSTARLIMAB,an anti-PD1monoclonal antibody,every three
weeksfor six months asa first-line treatmentfor locally advancedmismatch
repair-deficient(MMRD) rectalcancer.
 This clinical trial continues to enroll patient and is currently enrolling patients with
gastric, prostate and pancreatic cancer.
 As the incidence of rectal cancer is rising in young adults, this approach can have a major
impact. The focus of this presentation is to summarize the existing knowledge regarding
DOSTARLIMAB and exploring the possibilities of mono and combination therapies.
KEYWORDS: DOSTARLIMAB, PD-1 Inhibitor, Rectal Cancer, Clinical Trials.

4. INTRODUCTION:
 DOSTARLIMAB, a monoclonal antibody medication, has been referred to as a
"possible cure for cancer" for the first time ever.
 All 18 rectal cancer patients in a clinical trial run by the Memorial Sloan
Kettering Cancer Center in the US in 2022 realized that their cancer had
vanished within six months of receiving an experimental dose of this hopeful
breakthrough drug.
 Duringthe sixmonths of the trial,participantsreceivedatleast nine doses of the
medicationevery threeweeks.All patientsdisplayeda clinically full responsewith
no evidenceof a tumor atthe endof the timeperiod.Chemotherapy,radiation
treatments,endoscopy, biopsies, andinvasivesurgerywereadministeredafterthe
initialtreatment.
DOSTARLIMAB
• JEMPERLI(Trade
Name)
MONOCLONAL-
ANTIBODY
• PD-1
RECEPTOR
BLOCKER
TREATMENT
• ENDOMETRIAL
CANCER
• RECTAL
CANCER

5. What is Rectal Cancer ?
Rectal cancer is a Tumor that arises from the lowermost part of the
digestive tract, just proximal to the anal canal.
It usually spreads to the lymph nodes that line it, in which case it is
called a locally advanced cancer, prior to its spread to distant organs,
where it is deemed as a metastatic or advanced disease . Rectal
cancer is usually detected in advanced stages as it is generally
ignored by thinking its piles.
Stage 0 :
Cancer cells
have been
found on the
rectal lining
surface.
Stage 1: The
tumor has
grown below
the lining
into the
rectal wall.
Stage 2: The
tumor has
extended
into tissues
around the
rectum.
Stage 3: The
tumor has
invaded the
lymph nodes
next to the
rectum.
Stage 4: The
tumor has
spread to
distant
lymph nodes
or organs.
:

7. DOSTARLIMAB binds to PD-1 receptors on the T-cell, blocking
PD-L1/ PD-L2 interactions. This enables the T-cell to identify and
attack cancer cells restoring cytotoxic activity in the T-cell.

8. Dostarlimab is a monoclonal antibody that is derived from a mouse antibody
that was humanized via complementarity Determining Region (CDR) grafting.
Its plasma half-life is very long i.e., 25.4 days. Patients with rectal cancer who
have advanced or recurrent disease that is mismatch repair deficient (dMMR)
and who have progressed during or after prior therapy with a platinum-
containing regimen have been found to benefit from the use of the PD-1
monoclonal antibody dostarlimab (JEMPERLI). Based on the rate of tumor
response and the duration of the response, both of which were assessed using
an FDA-approved test, this indication was swiftly authorized.

9. ADVERSE EFFECTS
Dostarlimab may cause serious side effects, such as:
•new or worsening cough, shortness of breath;
•chest pain, irregularheartbeats;
•a light-headedfeeling,like you might pass out;
•a seizure;
•confusion, hallucinations, eye pain or redness,vision problems;
•severe stomach pain, nausea, vomiting, diarrhea,bloody or tarry stools;
•low red blood cells(anemia)--paleskin, tiredness, cold handsandfeet;
•low white blood cellcounts--fever, mouth sores, skin sores, sore throat, cough;
•kidney problems--swelling in your ankles,blood in your urine, little or no urination;
•liver problems--right-sided upper stomach pain, loss of appetite, bruising or bleeding,dark
urine, jaundice(yellowingof theskin or eyes); or
•signs of a hormonal disorder--frequent or unusual headaches,dizziness, feelingvery weak,
mood or behavior changes, hoarse or deepenedvoice, increased hungeror thirst, increased
urination, constipation, hairloss, sweating, feelingcold, weight gain or loss.
Your cancer treatments may be delayedor permanentlydiscontinued if you havecertain side
effects.
Common side effects of dostarlimab may include:
•abnormal liver function tests;
•nausea, diarrhea, constipation;
•low white blood cellcounts, anemia; or
•feelingweak or tired.

10. CLINICAL TRIAL
A tumor is an unchecked cell development in one area of the body that has the
potential to spread to other sections of the body. Depending on their capacity to
metastasize, tumors are classified as either cancerous (malignant tumors) or non-
cancerous (benign tumors). Locally advanced rectal cancer is often treated with
neoadjuvant chemotherapy and radiation, followed by surgical rectum resection. A
lack of mismatch repair is the root cause of several types of rectal cancer.
It was believed that checkpoint blockade would be helpful in patients with locally
advanced rectal cancer that lacks mismatch repair because metastatic mismatch
repair-deficient colorectal cancer responds to PD-1 blocking in that setting.
Dostarlimab, a monoclonal antibody medication, has been referred to as a "possible
cure for cancer" for the first time ever in history.
Aim
 The goal of Dostarlimab treatment is to achieve a cure for colorectal cancer, improving the
life span of the patients.

11. OBJECTIVE
• Dostarlimabslows the growthof tumors andboosts the immune system'sability to
combat cancercells.
• Adultswho have previously receivedtreatmentfor a certaintype of solid tumor may
also use dostarlimabinjection to treatthe tumor'sspreadto new organs
METHOD
We starteda prospectivephase 2 researchin whichpatientswithstageII or stageIII
rectalcancer receivedsingle-agentdostarlimab,ananti-PD-1monoclonal antibody,
everythree weeksfor sixmonths. Following this therapy, regularchemotherapy and
surgerywereto be administered.Theprimaryendpointsareoverall response to neo-
adjuvantdostarlimabtherapy withorwithout chemo-radiotherapyandsustainedclinical
full response following completion of dostarlimabtherapy withor without chemo-
radiotherapy.

12. RESULT
Twelve patientshave finished dostarlimabtherapy and experienced at least six
months of follow-up. Clinicalfullresponse was observed in all 12 patients(100%; 95%
confidenceinterval,74–100), and no tumor was visibleon magneticresonance
imaging(MRI), digitalrectal examination, endoscopic examination, or biopsy. No
patientshad undergone surgery or chemo-radiation therapy at the time of this
report, and there had been no progression or recurrence instancesrecorded during
follow-up (range, 6–25 months). Before that, no negativeconsequenceswere
observed.
Conclusions
Mismatch repair-deficient, locally advanced rectal cancer was highly sensitive
to single-agent PD-1 blockade. Longer follow-up is needed to assess the
duration of the response.

13. TREATMENT
One of the four pillars of cancer treatment, immunotherapy, has lately come to
light as a source of hope for cancer patients. A number of immunotherapies,
including immune checkpoint inhibitor therapy, monoclonal antibody therapy,
and chimeric antigen T-cell therapy, have drawn a lot of attention due to their
exceptional abilities to stimulate the immune system to recognize cancer cells
and respond by preventing the spread of those
cells.

14.  Dostarlimab, a monoclonal antibody against the programmed cell death
protein (PD-1) that has been shown to completely (100%) cure patients with
colorectal cancer, has enchanted the medical community in this period of
rapid advancement. Also, none of the study participants experienced any
significant negative effects, according to the findings of clinical trials.
 Dostarlimab has also demonstrated encouraging outcomes in the treatment of
breast cancer, melanoma, head and neck cancer, endometrial cancer, and
ovarian cancer.
Adults with advanced or recurrent mismatch repair deficient (dMMR) cancer may
be treated with dostarlimab including:
• Platinum chemotherapy was used to treat endometrial cancer, but it proved
unsuccessful or is no longer effective.
• Solid tumors that got worse during or after other treatments and cannot be
addressed with other therapies.
This use is approved under FDA’s Accelerated Approval Program. As a condition
of approval, confirmatory trial(s) must show that dostarlimab-gxly provides a
clinical benefit in these patients.