• Lewis

Part Twenty-one: Nivolumab, clinical trials and the benefits of transplant

Updated: Sep 26, 2020

A bit of a different post this time. As promised previously I have drawn up a post which will explain all about the drug Nivolumab which as you will be aware is my next step, the idea and process of clinical trials, and why we are so dead certain on getting a stem cell transplant upon gaining remission status. Buckle up, it’s going to be a long, but hopefully an interesting one and as they say every day is a school day!

Human’s immune systems protect against viruses, bacteria and fungus. They also provide protection against cancer cells. Usually, your immune system can seek out and destroy malignant cells before they pose an issue. However, sometimes the cancerous cells can camouflage themselves by adding a protein onto their surface to make themselves look like a normal cell. The protein then fits seamlessly with a receptor on your immune cells. This action prevents the immune system from recognising and destroying the cancer cells. Nivolumab is a checkpoint inhibitor which blocks the interaction between these two proteins allowing your immune system to recognise and destroy malignant cells.

The drug Nivolumab has many uses in the world of oncology. It can be used to treat a variety of cancers ranging from lung cancers and melanoma to Hodgkin’s Lymphoma. It is a drug that has not been used for long in Hodgkin's - typically only late in the disease when all else has failed to intend to prolong life. This is mainly down to the fact that Nivolumab comes with a very limited number of side effects, therefore increasing quality of life and as more about treatments is understood, they come closer to front line therapy should they be successful. That's the situation we are in now. Studies have shown Nivolumab has proved efficient against HL that is refractory to all other treatments. Naturally, the world of haemato-oncology wonders Nivolumab can provide successful outcomes earlier without the toxicities of chemotherapy. That is where the trial I have signed up for fits in. "ANIMATE" is an international study into the effectiveness of Nivolumab as a second-line therapy after one prior treatment post relapse has not provided remission. Using Nivolumab in this setting is a relatively unknown entity. There has been one previous trial that looked at Nivolumab's success post first relapse. The study showed good results; however, it only had 36 participants, so further research is most definitely warranted.

The ANIMATE trial, like all other clinical trials, have a specific protocol that they follow alongside strict guidelines. Clinical trials are also split into stages. Stage One is used to identify the safest and most effective dose and how to deliver the drug to the patient; it also aims to identify potential side effects of the treatment. Stage Two is where the drug is trialled on a small number of participants to see how effective the treatment is. Stage Three then incorporates a much more substantial amount of patients to see if the treatment on offer is more successful than the standard treatment for the disease. The ANIMATE trial is currently at stage two and is managed by the University College London. At stage two, everyone receives Nivolumab.

You are given one dose of Nivolumab every two weeks for eight weeks. The infusion lasts a few hours, and no overnight stay is required. After four weeks, you undergo a PET scan. If the PET scan shows a complete response, then I will undergo a transplant. If there has been a response or the uptake stays the same, then I will undergo a further four cycles (eight weeks) of Nivolumab treatment. In the unfortunate event of progressive disease, then I will exit the trial. Fortunately it appears that Nivolumab comes with no where near the side effects that accompany chemotherapy. Sickness, low blood counts and generally feeling shi*e shouldn’t be an issue.

Trials are vital in their ability to change lives and in the propulsion of medicine. Without trials, many diseases that were rendered incurable only ten years ago would not be curable now. Many people would not have lived to see children grow up, to get married and to enjoy life. Trials are crucially important, and that is why I have taken the opportunity to join this one. Not that I am desperate but the fact that it could change my life and those of many people in the future.

Another successful treatment, which was the result of research and trials now finds itself a the forefront of medicine. Stem cell transplants are used in a range of conditions from blood cancers like mine to the treatment of Multiple Sclerosis. There are two types of stem cell transplants (SCT) - autologous, where your own stem cells are used and allogenic where a donor’s stem cells are used. SCTs are very useful as they allow vast doses of chemotherapy to be given, which your body couldn’t usually recover from. This increases cure rates. By reinfusing the stem cells, your bone marrow can rejuvenate its self. Allogenic transplants also provide the luxury where the cells of the donor recognise malignant cells and can kill them. Having a transplant after gaining remission can increase cure rates from 20% to 70%+ making the nasty side effects and long recovery times worth the effort. However, as usual, I will post an explanation of how transplant’s work when we can decide which type of transplant will be most beneficial for me.