Dostarlimab

How it works

It binds the programmed death-1 (PD-1) receptor on T cells, blocking its interaction with PD-L1 and PD-L2 and restoring T-cell-mediated antitumour immune responses.

Prescribing in practice

• It can cause immune-related adverse effects affecting any organ system, including the lungs, bowel, liver and endocrine glands, which may be severe and require corticosteroids and treatment interruption.
• Mismatch-repair or microsatellite-instability status guides patient selection for the relevant indications.
• It is given by intravenous infusion under specialist oncology supervision.

Monitoring

Monitor for immune-related adverse reactions, including liver, thyroid, adrenal, lung and bowel involvement, before and during treatment.

Counselling the patient

• Report new or worsening symptoms such as diarrhoea, cough, breathlessness, rash or unusual tiredness promptly.
• Carry an alert that you are receiving immunotherapy so other clinicians are aware.

Evidence & guidelines

Dostarlimab is supported by trial evidence in mismatch-repair-deficient tumours and is appraised by NICE within its licensed indications.