A recent publication of two fatal cases of myocarditis with Bristol Myers Squibb’s (NYSE:BMY) combination of Opdivo (nivolumab) and Yervoy (ipilimumab) has oncologists downplaying concerns regarding the usage of these types of medications. However, they added proper education about the detection and treatments of these side effects will be crucial after more widespread adoption in clinical practice.
The article published in the New England Journal of Medicine on 3 November [Johnson DB et al. New England Journal of Medicine. (2016); 375: 1794-1755] gained significant media attention with a number of news outlets reporting the myocarditis – inflammation/damage of the heart muscle -- side effects as worrisome. However, oncologists cautioned that these side effects, even though serious, are low in incidence. Oncologists also noted that deaths from toxic chemotherapy, which was used prior to the advent of the checkpoint inhibitors drugs, occurred at a much higher rate.
Opdivo/Yervoy is under investigation across a wide range of oncology indications including non-small-cell lung cancer (NSCLC), small-cell lung cancer, gastrointestinal cancers, renal cell carcinoma as well as many others. Opdivo/Yervoy is approved as a combination for the treatment of melanoma.
Opdivo is a PD-1 inhibitor, approved for melanoma, second line NSCLC, renal cell carcinoma, Hodgkin’s lymphoma and second line head and neck cancer. Yervoy is a CTLA-4 inhibitor approved for the treatment of melanoma.
A number of other companies are developing similar combinations, such as Merck (NYSE:MRK) who is investigating their PD-1 inhibitor, Keytruda (pembrolizumab) with Yervoy across a variety of indications. AstraZeneca (LON:AZN) is developing its PD-1 inhibitor, durvalumab, in combination with its own CTLA-4 inhibitor, tremelimumab.