Nivolumab

I've been seeing a lot of reports from the International Conference on Malignant Lymphoma in Lugano, Switzerland. There wasn't much on Follicular Lymphoma from this year's ASCO conference. Chicago is a wonderful city, and I've enjoyed myself the few times I've been there. But if some Lymphoma researcher had to choice to go to Switzerland instead? Yeah, that's where I'd go, too. (Spent a day in Zurich once, many years ago. It was gorgeous. I got a ticket for not wearing my seatbelt while driving in the Swiss Alps. I'd still take Lugano over Chicago.)

Anyway, it looks like there has been some good stuff being presented over there. One presentation involved a small phase I trial for Nivolumab, a monoclonal antibody that targets PD-1.

International Conference on Malignant Lymphoma in Lugano, Switzerland.
- See more at: http://www.onclive.com/conference-coverage/ICML-2015/Nivolumab-Elicits-Durable-Responses-in-Lymphoma#sthash.zUdO31OE.dpuf

PD-1 has been getting a lot of attention in the last couple of years, and it is seen as a potentially excellent target for treatments. PD-1 stands for "Programmed Death." Normal cells have a kind of expiration date built in to them; cancer cells find ways to block that expiration date, so they keep on living even after they were supposed to die. One way this happens is when a ligand called PD-L1 attaches to the PD-1 (the L in PD-L1 stands for "Ligand," which is a substance that attaches to something else -- that's a big oversimplification).

So PD-1 (good) gets blocked by PD-L1 (bad), so we need something to block that. And that's where Nivolumab (good) comes in. Nivolumab allows PD-1 to do its job, and let the cells die the way they are supposed to. No runaway cells means no cancer.

The trial involved 104 "heavily pre-treated" patients with a bunch of different types of blood cancers. Of those 104, 31 had some kind of B-Cell Lymphoma. I can't tell how many of those had Follicular Lymphoma, but the results for that group look pretty good:  The Overall Response Rate was 75%, and after 82 weeks (about a year and a half), most of those patients had still not had the FL return.

Nivolumab seems pretty effective in a whole bunch of cancers, not just the liquid kind that we are all familiar with. It will be interesting to see if, in a few years, we see some trials involving Nivolumab in combination with something like Rituxan or another targeted treatment that seems more geared toward Lymphoma, specifically.

The usual warning applies here -- this is a phase I trial, so there's a long way to go before you see this in the treatment room. But it does show that, once again, targeted therapies seem to be where we are headed.

In those with follicular lymphoma, the ORR was 75% with a duration ranging from 27 to greater than 82 weeks. Most responses remained ongoing at the time of the analysis. - See more at: http://www.onclive.com/conference-coverage/ICML-2015/Nivolumab-Elicits-Durable-Responses-in-Lymphoma#sthash.zUdO31OE.dpuf