Combination immunotherapy: the emerging treatment that removes cancer’s “cloak of invisibility”BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1824 (Published 30 April 2019) Cite this as: BMJ 2019;365:l1824
- Ingrid Torjesen, freelance journalist
- London, UK
Last year’s Nobel prize in physiology or medicine went to James P Allison and Tasuku Honjo for their work on cancer immunotherapy. Some doctors think that the emerging use of these treatments in combination, and with other treatments such as chemotherapy and radiotherapy, will lead to a step change in survival rates, particularly in cancers that are hard to treat.
Ten years ago patients with a diagnosis such as melanoma or lung cancer, which don’t respond well to traditional methods such as chemotherapy and radiotherapy, received a grim prognosis. Immunotherapy has changed this for some patients. For example, a randomised trial of 272 patients with advanced, previously treated squamous cell non-small cell lung cancer (NSCLC) found that the immunotherapy nivolumab (Opdivo, Bristol-Myers Squibb) increased one year survival to 42%, compared with 24% with chemotherapy (docetaxel).1
But in most patients the cancer either doesn’t respond fully to immunotherapy drugs or becomes resistant. By combining different immunotherapies and other treatments including radiotherapy and oral targeted therapies, researchers hope that more patients will respond and for longer.
Nivolumab (Opdivo, Bristol-Myers Squibb) plus ipilimumab (Yervoy, Bristol-Myers Squibb) was the first combination immunotherapy to be licensed in the US and Europe and has been used in melanoma for several years. Now, pembrolizumab (Keytruda, MSD), combined with a standard chemotherapy, has become the first such combination therapy to be licensed in lung cancer, receiving marketing authorisation last year for first line use in patients with metastatic non-squamous NSCLC in the US and Europe after a trial showed that the combination boosted survival.2
Tumour cells, like …