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NICE approve the use of Dostarlimab

Biggest breakthrough in Endometrial Cancer treatment in a generation will bring hope to many with advanced or recurrent disease

The announcement today of a decision from NICE to approve the use of Dostarlimab for certain types of advanced or recurrent endometrial cancer is a momentous breakthrough in the treatment of this devastating disease.

Womb (uterine) cancer is the most common cancer of the female reproductive organs, affecting nearly 10,000 people in the UK every year. More than 90% of womb cancers occur in the endometrium, so called endometrial cancers. When womb cancer is diagnosed early, the survival is often very good, but sadly for those diagnosed with advanced or recurrent disease, less than half will survive for more than one year and around 2,400 people die each year in the UK from womb cancer.

Most people with advanced or recurrent cancer are treated with chemotherapy, medications which work by killing cancer cells. Once patients have had this treatment, there was previously no second-line medication licensed or recommended. The approval of Dostarlimab will provide hope for many of those facing this frightening reality and may improve their survival and quality of life.

Dostarlimab is a newer type of cancer treatment called immunotherapy. It works by stimulating the person’s immune system to fight the cancer. Dostarlimab is a type of immunotherapy called a monoclonal antibody. It attaches to a protein called PD-1 on the surface of the womb cancer cells, helping the immune system to recognise and attack the cancer cell.  In the GARNET trial, Dostarlimab was successful in shrinking tumours in 42% of patients, giving them longer survival than other current treatment options, with few side effects (1). Dostarlimab has been approved for use in people whose cancer has a specific change in the DNA called microsatellite instability (MSI) or mismatch repair deficiency (dMMR) as it is in these people that it has been shown to be effective. Around 25% of those with advanced or recurrent endometrial cancer, including people with Lynch syndrome, have this specific change in the DNA (2) and today’s wonderful news will bring hope to them.

 We are delighted by this announcement and hope that it heralds a wave of new treatment options to improve the lives and survival of all those with advanced and recurrent womb cancer.

Professor Emma Crosbie, Chair of Trustees of Peaches Womb Cancer Trust, said “This new treatment will benefit patients with advanced or recurrent endometrial cancer, who currently have very few effective anti-cancer treatments available to them. We desperately need more research to help us find new ways of preventing, diagnosing and treating endometrial cancer.”

Dr Eleanor Jones, Trustee and Head of Communications at Peaches Womb Cancer Trust said “Every year, thousands of people across the UK face the crushing reality of a diagnosis of endometrial cancer. For those with advanced cancer, there are still relatively few treatment options that can improve their lives or prognosis. Today’s decision is really welcome news and we hope it is just the beginning of wider progress in the treatment and care of people affected by this devastating cancer.”

Helen White, Patient Volunteer at Peaches Womb Cancer Trust said “This is very welcome news for people with advanced or recurrent womb cancer who have this specific DNA change (dMMR/MSI). Approval of Dostarlimab means they will now get personalised treatment, which promises to improve all-important quality of life and time with family and friends.”

Peaches Womb Cancer Trust commented in support of this NICE appraisal and we are delighted that it has been approved. You can read more about the work that we do here and through our social media channels.

The decision made by NICE in England today will also be replicated in Wales and Northern Ireland immediately. A decision is expected in Scotland later this year.

References

1. Oaknin A, Tinker AV, Gilbert L, Samouëlian V, Mathews C, Brown J, et al. Clinical Activity and Safety of the Anti-Programmed Death 1 Monoclonal Antibody Dostarlimab for Patients With Recurrent or Advanced Mismatch Repair-Deficient Endometrial Cancer: A Nonrandomized Phase 1 Clinical Trial. JAMA oncology. 2020;6(11):1766-72.

2. Ryan NAJ, McMahon R, Tobi S, Snowsill T, Esquibel S, Wallace AJ, et al. The proportion of endometrial tumours associated with Lynch syndrome (PETALS): A prospective cross-sectional study. PLoS Med. 2020;17(9):e1003263.