Immunotherapies are a new class of drugs that have been developed to stimulate a person’s own immune system to recognize and destroy cancer cells. Several immune checkpoint inhibitors are now available that seem to release the brakes of the immune system, allowing it to mount a stronger and more effective attack against cancer cells. These drugs target proteins on immune cells that act like brakes, or checkpoints. By releasing these immune brakes, the drugs allow a stronger and more powerful immune attack against cancer.
Since 2012, several types of immunotherapies have been approved in Canada for the treatment of advanced unresectable or metastatic melanoma (stages IIIC – Stage IV), including pembrolizumab (Keytruda), nivolumab (Opdivo) and ipilimumab (Yervoy).
Side effects of these drugs can include fatigue, cough, itching, skin rash, decreased appetite, constipation, joint pain, and diarrhea. Other more serious side effects occur less often. As these drugs work by basically removing the brakes from the body’s immune system, sometimes the immune system starts attacking other parts of the body. This can cause serious or even lifethreatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
It’s very important to report any new side effects to your health care team promptly. If serious side effects do occur, treatment may need to be stopped and you may be prescribed high doses of corticosteroids to suppress your immune system.
Current immunotherpay drugs available in Canada:
Ipilimumab (Yervoy): This immunotherapy helps the body’s immune system recognize and destroy melanoma cells. It blocks CTLA-4, a protein on T cells that normally helps keep them in check. Ipilimumab is given intravenously. One dose is given every three weeks for four treatments. Ipilimumab can lengthen life in people with advanced disease with melanoma that can’t be removed by surgery or that has spread to other parts of the body (stage IIIC – IV). Often, ipilimumab is prescribed in combination with nivolumab, which has resulted in longer progression-free survival and a higher objective response rate than ipilimumab alone.
Pembrolizumab (Keytruda): This drug is an immune checkpoint inhibitor that targets PD-1, a protein on immune system cells (called T cells), that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against melanoma cells. This can often shrink tumours and help people live longer. These drugs are given as an intravenous (IV) infusion every 3 weeks.
Nivolumab (Opdivo): This is an immune checkpoint inhibitor that targets PD-1, a protein on immune system cells (called T cells) that normally help keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against melanoma cells. This can often shrink tumours and help people live longer. These drugs are given as an intravenous (IV) infusion every 2 weeks. Often, nivolumab is prescribed in combination with ipilimumab, which has resulted in longer progression-free survival and a higher objective response rate than ipilimumab alone.
Under Review Combination Therapy
Nivolumab (Opdivo) + Ipilimumab (Yervoy): Cancer cells may exploit “regulatory” pathways, such as checkpoint pathways, to hide from the immune system and shield the tumor from immune attack. OPDIVO® and YERVOY® are immune checkpoint inhibitors that target separate, distinct and complementary checkpoint pathways (PD-1 and CTLA-4).1 which increases your body’s immune response. The drugs activate immune cells—unleashing them, in effect—so that they can invade tumors and attack melanoma cells.
Get the latest melanoma news straight to your inbox. Sign up for the Melanoma Patient Exchange Newsletter.
Melanoma What You Need To Know
A leading national melanoma resource written with the help of specialists in oncology and health care.