Page 9 - Inspire Autumn/Winter Edition 2017
P. 9

Fact or Fiction?

        “I thought I’d start running again and the doctors said that would be ok. I started on nivolumab in March, began running
        in June, and I did a half marathon in October. Immunotherapy was starting to work; my tumours had shrunk considerably.

        “In April this year, I ran the Brighton Marathon. Now, I’ve completed ten half marathons and a full marathon.

        “I’m now in remission, with no detectable disease. It’s astonishing, I know. You don’t think this really happens – but it does!”

        Laura’s story is certainly inspiring, but it’s also highly unusual. We need to be realistic about immunotherapy. Only around
        one in five patients responds at all, and while a small number will do very well, some will see almost no benefit or their
        tumours may shrink for a while before returning.

        That’s an outcome Daniel Cohen recognises all too well.
        His wife Katie was diagnosed with advanced lung cancer in
        January 2015. As conventional chemotherapy caused her
        severe side effects, the couple used private health insurance
        to pay for nivolumab. It has been shown to be kinder to
        the body, with fewer disabling side-effects.

        Said Daniel: “After chemotherapy I would bundle Katie into
        the car and take her home to bed, but after immunotherapy
        she could walk out and we went for lunch”.

        Sadly, the treatment stopped working and Katie’s tumours
        began growing again. Although her doctors tried two
        immunotherapy drugs in combination – ipilimumab
        (brand name Yervoy) and nivolumab, her cancer did not
        respond and she died in April. She was just 34.

        Daniel adds: “Immunotherapy bought her time. We had
        hoped it would give us more years, but that wasn’t the case”.
                                                                                         Katie and Daniel on their honeymoon.
        Immunotherapy is still a new and expanding area. The drugs
        are expensive to make and to buy, which is why it can take           We had hoped it would
        time for them to be approved for NHS patients in all parts of
        the UK. Some can cost as much as £100,000 per patient per year.        give us more years,
                                                                           but that wasn’t the case.
        In England, NICE (National Institute for Clinical Excellence) has                                  ”
        the task of evaluating therapies and weighing costs against benefits. North of the border, the Scottish Medicines Consortium
        (SMC) has a similar role. Since the two organisations use different criteria, they sometimes make different decisions about
        similar therapies. This is why patients in Scotland with the ‘right type’ of lung cancer have been eligible to receive nivolumab
        since 2016, while their counterparts in England had to wait until September 2017 for access via the CDF to be approved.

        For all the complexities, the addition of immunotherapy to the range of treatment options for lung cancer is a very
        welcome advance, according to oncologist Dr Marianne Nicolson.

        “These drugs really are a new dawn in lung cancer. We’re doing lots of clinical trials, both early on and in later stage, to
        identify how many more patients can benefit. Immunotherapy is a great progression.”

        And, as Laura Bagnall knows, for the fortunate few who respond well, it can offer a way back to a better quality of life.
        However, a word of caution here. Immunotherapy is not a ‘miracle’ – although it does point to a brighter future. More
        research is needed to improve its effectiveness. We’re not there yet but, in the long run, we can expect better outcomes.

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