What does it mean when you have rectal cancer that can no longer be detected by PET scans, MRI, or endoscopy? It means you no longer have cancer.

And that is the case in a small study (n=18) in New England Journal of Medicine which detailed results of  the checkpoint inhibitor dostarlimab. Eight doses over six months at $11,000 per dose means not only sparing patients chemo, radiation, and surgery, it means saving the health care system millions per patient.

The patients were all chosen for locally advanced rectal cancer, so it had not spread to other organs, with the goal of seeing if checkpoint inhibitors got a boost being early. And the results look promising, though obviously this needs a much larger, much more expensive, time-consuming trial - and about a billion dollars to get through FDA paperwork.

It is often the case that small companies can never get to market because of the bureaucratic process. After some were harmed due to Vioxx approval, grandstanding members of Congress decided making trials twice as expensive would make products safer. That is obviously not scientific but we've been stuck with giant pharmaceutical companies buying early stage ones since, because investors can't take a billion-dollar risk. So GlaxoSmithKline bought Tesaro and really didn't even know they were doing the trial.

It may turn out to be a big win for them.