The new drug nivolumab-Opdivo, a type of vaccine in lung cancer treatment, has made a difference

We continue our first article titled "The Shining Three Musketeers of Cancer Treatment" with nivolumab (Porthos). Following ipilimumab (Yervoy) treatment for the skin cancer called malignant melanoma, treatments activating the immune system rapidly gained importance. Based on the knowledge obtained, new braking mechanisms were identified that could mobilize the knocked-out immune system in cancer patients. PD-1, also known as programmed cell death protein, is a receptor on the surface of immune cells. A protein ligand called PD-L1 released by cancer cells binds to this receptor, activating the immune system's braking mechanism against cancer. After two drugs developed against these protein structures, nivolumab (Opdivo) and pembrolizumab (Keytruda), were proven effective in malignant melanoma, they were tested in lung cancer patients.

Lung cancers are considered under two main subgroups: Small Cell Lung Cancer and Non-Small Cell Lung Cancer . Non-small cell lung cancers consist mainly of three groups: adenocarcinoma, squamous cell cancer, and large cell cancer. For adenocarcinoma in this group, opportunities for chemotherapy and, in suitable patients, targeted treatment are considerably greater than for squamous cell cancer. We can say that studies until the last few years left inoperable squamous cell lung cancer orphaned in terms of treatment options compared with the adenocarcinoma subtype. In the last few years, however, testing drugs such as nivolumab and pembrolizumab (immune checkpoint regulators), which release the immune system's braking mechanism, in lung cancer has produced notable data. Perhaps the most important finding was that these drugs had a more pronounced effect in the squamous cell lung cancer subgroup than in the others.

In light of these data, the results of a study designed by Julie Brahmer and colleagues, called “CheckMate 017” were presented at the 2015 American Cancer Congress (ASCO) and published in the New England Jornal of Medicine, one of the scientific community's most respected journals, on 31 May.

In this study, the new drug was tested in patients with locally advanced (stage 3) or metastatic (stage 4) squamous cell lung cancer who had developed a lack of response after initial platinum-containing drugs, called standard treatment, with 272 patients enrolled. Nivolumab, the investigational drug tested as second-line treatment, was compared with the chemotherapy drug docetaxel, also accepted worldwide as standard second-line treatment.

The risk of death was found to decrease by %41 in patients receiving nivolumab, with overall survival 3.2 months longer. The patients' 1-year survival rates were almost twice as high in the nivolumab arm. Comparing the two drugs for the frequency of severe (grade 3-4) side effects, nivolumab caused side effects in %7, while docetaxel caused them in %55. The new drug was therefore also considered highly feasible in this respect.

In conclusion, nivolumab succeeded in leaving a revolutionary mark on lung cancer treatment in 2015. I hope that this drug, approved by the FDA in America on 4 March 2015, will soon become available in Europe and our country after the necessary regulatory reviews for patients with squamous cell lung cancer that has not responded to first treatment or has progressed.