17 June 2016
Two immunotherapy drugs, nivolumab and ipilimumab are approved for NHS use by NICE for the treatment of advanced melanoma despite the potential side-effects.
Melanoma is the sixth most common cancer in the UK; late stage melanoma has an average five-year survival rate of 15%-20%. Immunotherapy - getting the body to recognise cancer as an invader and fight it - is one of the most promising fields of ongoing cancer research. The new drugs, both produced by Bristol-Myers-Squibb (BMY) have both shown promise as monotherapies, but early data from a clinical study using the two together recorded an 18-month survival rate of 69%, almost double that of ipilimumab alone.
The two drugs work to suppress the ability of cancer cells ‘handshaking’ with the immune systems T-cells. Nivolumab blocks the PD-1 receptor in immune cells, receptors which cancer cells can u se to mask their presence. Ipilimumab binds to the CTLA-4 molecule key to regulating immune responses.
NICE have moved quickly to approve the combined therapy, a speedy result which has been helped by BMY agreeing to provide a discount to the NHS, bringing the cost of the therapy under NICE’s cost-effectiveness ceiling of £30,000 per year of quality life gained.
The two drugs have an extensive list of side-effects but NICE concluded that those effects, whilst severe did not outweigh the positives, but the toxicity of the treatment meant it was a "promising new advance" only for those patients strong enough to withstand the side-effects.