by Ron Sulla –

A new treatment is making waves throughout the cancer community called Opdivo. The treatment is seen as a breakthrough in how doctors will treat cancer in the future, and might be a better alternative to many other common chemotherapies which cause a variety of problems in their own right. In my quest to understand the potential of this new treatment, I interviewed Duncan Murray, an expert in the field of cancer immunology who also studied hematology at Cambridge and Oxford Universities.



In 2000, a paper came out titled “The Hallmark of Cancer” which gave us six reasons why cancer can carry out surviving. They are basic things like it carries on growing, doesn’t die, metastizes,
and develops blood vessels among other things. Recently, they updated it in 2011 in which they added a new category called “immune evasion.”
Basically, many believe that in order for cancer to appear in a person it has to go about evading the immune system somehow. Murray explained it to me this way: “Your immune system actually does a pretty good job of dealing with cancer. So in order for you to get cancer, your immune system has to have been subverted somehow. There is plenty of evidence that points to this. The easiest example is people with immunodeficiency diseases, such as HIV — they develop cancers much more rapidly.”


The problem, however, is that tumors find a way to suppress or inhibit signals that would usually go to our immune system and tell it to kill the foreign bacteria. The cancer essentially turns the body against itself, and instead of sending multiple attacks at the tumor, it does nothing at all. These suppressions are called “immune checkpoint inhibitors” which block communication from the tumor to the immune system. What Opdivo is supposed to do is “unlock” these signals once again. Opdivo is thus classified as a PD 1 blocker, meaning it harnesses the power of the immune system to fight and kill the cancerous cells by blocking the blocks set up by the tumor. Murray sums it up, “PD 1 blockers block the PD 1 receptor on the T Cell. By doing so, it allows the T cell to become effective again. So you can look at it as a double inhibition, its inhibition of inhibition, so you are essentially relying on the immune system to do the job for you.”



Back in March of 2006, a very similar drug to Opdivo called TGN1412 was withdrawn after many of the patients developed severe inflammatory reactions and experienced systemic organ failure after being administered the treatment. Later that year, the company behind the drug went bankrupt. Despite the overwhelming positive potential for the treatment, it is important to be wary of the negatives of the drug. The biggest risk is setting off the immune system in a detrimental way. Since the drug is stimulating the immune system to do the job of fighting the cancer for us, there is a chance that if something goes wrong, the system could turn against itself, and attack the body rather than the cancer.


So, how did the treatment get approved in the first place? Usually, drugs undergo a three step process before being approved for public use. Phase one is to check authenticity and to see what kind of toxic effect the drug may have. Phase two is to see if there is a good effect on the patient. Phase three is a randomized controlled trial which involves a large trial of many patients conducted over an extended period of time. But Opdivo was extremely unique in the way it got approved. “The drug was so groundbreaking” says Murray, “it was approved early just after the phase one and early phase two trials. It had such a positive effect, that they went ahead and approved it because people wanted to use it straightaway.”
This however did not come without some controversy in the cancer treatment community. From a statistical point of view, most drugs don’t even get through to the third phase, which is considered the “gold standard” ,and some believe it was far too early to approve a drug even as effective as this one. Nevertheless, the results speak for themselves. In a recent study conducted by Bristol-Myers Squibb, a biopharmaceutical company, they found that when tested alongside docetaxel – a standard form of chemotherapy- Opdivo reduced the chances of death among patients by a whopping 42 percent. This is especially extraordinary considering the fact that lung cancer is one of the worst diagnoses one can get.



What does this all mean for the future of cancer treatment? At the moment, not too much. Most of the research behind the drug is still in a very preliminary state and it might be years before a drug like this gains mainstream use. But the important point is that this treatment has an incredible amount of potential. The theory behind the drug is sound, and many doctors agree that the use of PD 1 blockers will have a large role in the future treatment of all sorts of cancers. Cancer is one of the worst, if not worst diseases in human history, killing an average of 8 million people a day. But with this drug, we are one step closer to finally putting an end to this horrible illness.