NICE approval of immunotherapy for melanoma is hopeful for kidney cancer.

By: Dr Rebecca Case-Upton BSc (Hons), PhD
Kidney Cancer UK, Medical Publications

It is great news for patients with kidney cancer that NICE have just approved a combination of 2 new immunotherapy drugs, nivolumab (Opdivo) and ipilimumab (Yervoy) for melanoma (skin cancer). These drugs will now be available on the NHS for this condition.

The reason this news is so exciting is that the clinical trials for nivolumab in renal cell carcinoma (kidney cancer) looked equally as promising as the melanoma trials.  A NICE appraisal for the use of nivolumab in renal cell carcinoma is currently underway and is due to be published this October which is only 4 months away.
This year there will be some big changes in cancer treatments. In its current form, the Cancer Drug Fund is finishing in July and there have been worries about the speed of appraisal and availability of drugs recommended by NICE in the new system. However the process of making these drugs available on the NHS for melanoma was done extremely quickly, so this bodes well for the future. The drug combination was only licenced in Europe a month ago and the UK will be the first European country to make the drugs available for melanoma, hopefully the same fast recommendation will follow for the use of nivolumab in renal cancer. Nivolumab was approved for renal cell carcinoma in America last November and hopefully in October it will be approved here.
How does nivolumab work?
Immunotherapies harness the immune system’s own ability to attack tumour cells. Tumours often develop ways of tricking the immune cells that they are normal cells. For example PD-1 receptors on the immune cells are activated by PD-1 molecule released by the tumour cell. PD-1 receptors, once activated by the tumour cell, act within the immune cell to dampen down the immune cell activity so it doesn’t attack the tumour and destroy it. However the drug nivolumab is a monoclonal antibody which binds to the PD-1 receptor but doesn’t activate it, in fact it shields the receptor from being activated by the tumour’s PD-1 molecule. So the immune cell response can’t be reduced by the tumour and the immune cell is more likely to attack and destroy the tumour.
Ipilimumab works in a similar way but on a receptor called CTLA-4 found on immune cells. Once activated, the receptor CTLA-4 also dampens down immune responses and the drug again blocks this from happening.
Both of these drugs have shown to be effective in shrinking and halting growth of tumours, however they are not without side effects. The most prominent being colitis (inflammation and bleeding of the bowel). Getting the balance right between the effectiveness of the drug and the side-effects for each individual will be something that needs to be developed in the future.
Many immunotherapies are looking promising
Immunotherapies in general are looking very promising for kidney cancer. The following website lists many different immunotherapy drug combination trials that are occurring at the moment. Although this is an American website, the list of locations in some of these trials do include centres in the UK. One of the phase III trials includes the nivolumab and ipilimumab combination.
http://www.cancerresearch.org/cancer-immunotherapy/impacting-all-cancers/kidney-cancer
It is important and hopeful to also consider that nivolumab and ipilimumab are not the only 2 immunotherapies available within the field of immunotherapy. There are many different compounds, receptors to block and a variety of combinations, as the list of trials on the above link suggests. The area of immunotherapy is looking very hopeful and the news that NICE are approving the drugs very quickly based on positive clinical trial results is fantastic news. We will watch very closely for any news on the nivolumab appraisal result due in October.