December 2015, Vol. 4, No. 6
FDA Approves Opdivo to Treat Advanced Form of Kidney Cancer
On November 23, 2015, the FDA approved Opdivo (nivolumab) to treat patients with advanced (metastatic) renal cell carcinoma, a form of kidney cancer, who have received a certain type of prior therapy.
“Opdivo provides an important therapy option for patients with renal cell carcinoma,” said Richard Pazdur, MD, Director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “It is one of few therapies that have demonstrated the ability to extend patients’ survival in treating this disease.” Temsirolimus, approved in 2007, is the only other FDA-approved therapy that has demonstrated overall survival in renal cell cancer.
Renal cell carcinoma is the most common form of kidney cancer in adults and forms in the tissues of the kidney that make urine. The National Cancer Institute estimates 61,560 new cases and 14,080 deaths from kidney and renal pelvis cancer in the United States this year.
“Additionally, Opdivo’s extended indication, from melanoma and non–small cell lung cancer to renal cell cancer, demonstrates how immune therapies can benefit patients across a wide range of tumors,” continued Pazdur.
Opdivo works by targeting the cellular pathway known as PD-1/PD-L1. By blocking this pathway, Opdivo may help the body’s immune system fight cancer cells. Opdivo is intended for use in renal cell carcinoma in patients who have received prior antiangiogenic therapy.
The safety and efficacy of Opdivo for this use were demonstrated in an open-label, randomized study of 821 patients with advanced renal cell carcinoma whose disease worsened during or after treatment with an antiangiogenic agent. Patients were treated with Opdivo or another type of kidney cancer treatment called everolimus. Those treated with Opdivo lived an average of 25 months after starting treatment compared with 19.6 months for those treated with everolimus. This effect was observed regardless of the PD-L1 expression level of patients’ renal cell tumors. Additionally, 21.5% of those treated with Opdivo experienced a complete or partial shrinkage of their tumors that lasted an average of 23 months, compared with 3.9% of those taking everolimus, lasting an average of 13.7 months.
The most common side effects of Opdivo for this use are conditions relating to abnormal weakness or lack of energy (asthenic conditions), cough, nausea, rash, dyspnea, diarrhea, constipation, decreased appetite, back pain, and arthralgia.
Opdivo also has the potential to cause serious side effects that result from the immune system effect of Opdivo (known as “immune-mediated side effects”). These severe immune-mediated side effects involve healthy organs, including the lung, colon, liver, kidneys, hormone-producing glands, and the brain.
The FDA granted the Opdivo application a breakthrough therapy designation, fast track designation, and priority review status. These are distinct programs intended to facilitate and expedite the development and review of certain new drugs in light of their potential to benefit patients with serious or life-threatening conditions.
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The association of POLE and POLD1 with colorectal cancer risk was demonstrated in 2013. Palles and colleagues studied families with a dominant pattern of inherited colorectal cancer and multiple adenomas through whole genome sequencing.1 Through these efforts, they identified germline mutations in POLE and POLD1 as high-penetrance genes predisposing to [ Read More ]