The Small Cell Lung Cancer Relapse

Immunotherapy

As promised from my doctor, small cell most always returns after the initial chemotherapy. Mine returned in my adrenal gland. At this point, Dr. Peyton decided it would be wise to refer me to me to Dr.Spigel in order to possibly enroll me in clinical trials that he was conducting with small cell and immunotherapy.

I never wanted to participate in clinical trials because of the possibility of receiving a placebo. Dr Spigel understood my sentiments, and he notified me that the FDA had recently approved Opdivo (Nivolimab) /Yervoy (Ipilimumab) as treatments for small cell lung cancer. I told him I wanted to try this method without being admitted to a clinical trial.

How Opdivo Works

Opdivo, also known by its generic name nivolumab, is a medication used in cancer treatment, specifically in the field of immunotherapy. It belongs to a class of drugs called immune checkpoint inhibitors. Here’s how Opdivo works:

1. Immune Checkpoint Inhibition: Opdivo works by blocking a protein called PD-1 (programmed cell death protein 1) on the surface of certain immune cells, particularly T cells. PD-1 is part of a pathway that regulates the immune system’s response to normal cells and cancer cells.
2. Activation of T Cells: T cells are a type of white blood cell that plays a crucial role in the immune system’s ability to recognize and destroy abnormal cells, including cancer cells. Normally, when T cells encounter PD-1 ligands (PD-L1 and PD-L2) on the surface of other cells, it inhibits the activity of the T cells, preventing them from attacking those cells.
3. Enhanced Immune Response: Cancer cells can exploit this PD-1 pathway to evade detection and destruction by the immune system. Opdivo works by blocking the interaction between PD-1 on T cells and PD-L1 or PD-L2 on cancer cells. By doing so, Opdivo releases the “brakes” on the immune system, allowing T cells to recognize and attack cancer cells more effectively.
4. Immune-Mediated Cancer Cell Death: With the PD-1 pathway inhibited, the activated T cells are better able to identify and destroy cancer cells. This process is a form of immune-mediated cell death, where the immune system actively targets and eliminates cancer cells.
5. Broad Applicability: Opdivo has been approved for the treatment of various types of cancer, including melanoma, non-small cell lung cancer, renal cell carcinoma, Hodgkin lymphoma, and others. Its success in clinical trials and real-world applications has made it an important component in the treatment of certain cancers.

It’s important to note that while Opdivo and other immune checkpoint inhibitors have shown promising results in many patients, not everyone responds to these treatments, and side effects can occur. The use of Opdivo is typically determined by a patient’s specific cancer type, stage, and other individual factors, and it is administered under the supervision of healthcare professionals.

How Yervoy Works

Yervoy, also known by its generic name ipilimumab, is another medication used in cancer treatment, specifically as an immunotherapy agent. It belongs to the class of drugs known as immune checkpoint inhibitors. Here’s how Yervoy works:

1. Targeting CTLA-4: Yervoy primarily targets a protein called CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), which is found on the surface of T cells, a type of immune cell. CTLA-4 is a checkpoint molecule that plays a role in downregulating the immune response, preventing T cells from attacking normal cells.
2. Blocking Inhibition: Yervoy works by blocking the inhibitory signals sent by CTLA-4. Normally, when T cells are activated to attack foreign or abnormal cells (including cancer cells), CTLA-4 acts as a brake, dampening the immune response. By inhibiting CTLA-4, Yervoy releases this brake, allowing the immune system to mount a stronger and more effective attack against cancer cells.
3. Enhancing T Cell Activity: The inhibition of CTLA-4 results in the activation and proliferation of T cells. These activated T cells are then better able to recognize and target cancer cells for destruction.
4. Inducing Immune Response: Yervoy promotes an anti-tumor immune response by boosting the activity of cytotoxic T cells, which are responsible for directly killing cancer cells. This immune-mediated response aims to enhance the body’s ability to fight and control the growth of cancer.
5. Use in Advanced Melanoma: Yervoy was initially approved for the treatment of advanced melanoma, a type of skin cancer. It has since been explored in combination with other cancer treatments and for various types of cancers, though its primary mechanism of action remains centered around CTLA-4 inhibition.

It’s important to note that while Yervoy has shown efficacy in some patients, it can also lead to immune-related adverse events (irAEs) due to the increased activity of the immune system. These side effects can affect various organs and systems and may require careful management by healthcare professionals. Like other immunotherapies, the use of Yervoy is typically determined based on the specific type of cancer, stage, and individual patient factors, and it is administered under the supervision of healthcare providers.

I personally never experienced any of the possible adverse events. The one question my doctor had is when to stop the treatments. He said there is no science to go on. Even though it appears my small cell cancer is under control, there is no science to tell him when to stop the treatment, My opinion, of course, was to keep going until we had a reason not to continue.

It didn’t take long for my employer, adminitered through Blue Cross, to decide they would not pay for both drugs so we had to drop the Yervoy from the treatment plan. By this time the cancer in my thyroid was gone, and my scans were basically clean. We continued with Opdivo December of 2022 when my employer decided they would not pay for Opdivo either. I understood it was extrememly expensive, but I could not pay 13k a month for the treatments.

My doctor and a company by the name of Payer Matrix (contracted to Community Health Systems) enrolled me in the Bristol Meyers Squibb assistance program. They paid for the drug for patients who cannot afford it. That provided my treatments through 2023.

In the first quarter of 2024, I have not been approved for that program. This is a developing story and I will update this page as soon as I have information.