Receiving an advanced non-small cell lung cancer (NSCLC) diagnosis can be overwhelming, but there are paths forward.
Firas Badin, MD of Baptist Health, specializes in hematology oncology with a focus in lung cancer and believes in an individualized treatment approach for his patients. Here's what Dr. Badin says you may expect from an advanced NSCLC diagnosis and what you can do for a loved one with the disease:
How do you work with newly diagnosed patients and their caregivers to decide on a treatment plan?
Dr. Badin: The first step is to conduct the necessary tests to know three things: the exact type, stage, and molecular profile of the cancer. I usually do not start treatment until I do biomarker testing to find out the specific genes or proteins that can help establish the course of treatment. One specific biomarker we look for during testing is PD-L1. PD-L1 status can help us determine if immunotherapy- or dual-immunotherapy-based treatments may be an option for the patient.
Of course, it’s also very important to listen to the patient’s preferences. I try to educate caregivers and patients on all of their options and answer any questions they might have so they feel as informed as possible about their treatment plan. Two things I focus on when I am discussing treatment options are the efficacy and safety of the regimen.
Are there any treatments other than chemotherapy and surgery that patients may not know about?
Dr. Badin: There are a number of treatment options out there, but thanks to scientific progress, one treatment type that may offer hope for certain patients with previously untreated advanced NSCLC is dual immunotherapy. In 2020, the US Food and Drug Administration approved the first dual immunotherapy, Opdivo® (nivolumab) and Yervoy® (ipilimumab), for certain newly diagnosed NSCLC patients. Opdivo and Yervoy are prescription medicines used in combination as a first treatment for adults with advanced-stage NSCLC that has spread to other parts of the body (metastatic) and tests positive for PD-L1 but does not have an abnormal EGFR or ALK gene.
It's important to add that Opdivo and Yervoy can cause problems that can sometimes become serious or life-threatening and can lead to death. Serious side effects may include lung problems; intestinal problems; liver problems; hormone gland problems; kidney problems; skin problems; eye problems; problems in other organs and tissues; severe infusion reactions; and complications of stem cell transplant, including graft-versus-host disease (GVHD), that uses donor stem cells (allogeneic). Call or see your healthcare provider right away for any new or worsening signs or symptoms. Please see important safety information below.
What is dual immunotherapy and how does it work?
Dr. Badin: Immunotherapy is a type of treatment that uses a person’s own immune system to fight cancer by helping the immune system find and attack cancer cells. Dual immunotherapy is the combination of two immunotherapy treatments that can help attack cancer cells by targeting different immune checkpoints. Immune checkpoints help keep the immune system in check — they engage when proteins on the outside of T cells (a type of immune cell) stick to proteins on other cells, such as some tumor cells.
Opdivo and Yervoy is a combination of two immunotherapies that work with your immune system in different ways to help fight cancer. Yervoy may stimulate the kind of cells that help fight cancer, while Opdivo may help these cells find and fight the cancer cells again. In doing so, Opdivo and Yervoy can also attack and affect healthy cells. These problems can sometimes become serious or life-threatening and can lead to death. These problems may happen any time during treatment or even after treatment has ended. Patients may have more than one of these problems at the same time. Some of these problems may happen more often when Opdivo is used in combination with another therapy.
How do you suggest caregivers can best help patients in a clinical setting?
Dr. Badin: As I mentioned before, it is important to have open conversations with patients when discussing treatment options. I also think it’s very important for caregivers to attend medical appointments and take an active role in these conversations by asking key questions and taking notes on behalf of the patient — especially since patients are often overwhelmed after an advanced NSCLC diagnosis and may find it difficult to process this information. I often have patients bring their adult children to appointments as their caregiver, and their role is invaluable.
What questions do you recommend caregivers ask a patient's oncologist when discussing treatment?
1. What type and stage of lung cancer does my loved one have?
2. What types of diagnostic testing will they need to help determine the appropriate treatment course?
3. What treatment options may help my loved one live longer? Is dual immunotherapy an appropriate option?
4. What is the treatment schedule like and how will it impact their daily routine?
You can learn more about Opdivo and Yervoy at Opdivo.com.
Indication
OPDIVO® (nivolumab) is a prescription medicine used in combination with YERVOY® (ipilimumab) as a first treatment for adults with a type of advanced stage lung cancer (called non-small cell lung cancer) when your lung cancer has spread to other parts of your body (metastatic) and your tumors are positive for PD-L1, but do not have an abnormal EGFR or ALK gene.
It is not known if OPDIVO is safe and effective in children younger than 12 years of age with melanoma or MSI-H or dMMR metastatic colorectal cancer.
It is not known if OPDIVO is safe and effective in children for the treatment of any other cancers.
Important Safety Information for OPDIVO® (nivolumab) + YERVOY® (ipilimumab)
What is the most important information I should know about OPDIVO + YERVOY?
OPDIVO and YERVOY are medicines that may treat certain cancers by working with your immune system. OPDIVO and YERVOY can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. You may have more than one of these problems at the same time. Some of these problems may happen more often when OPDIVO is used in combination with another therapy.
Call or see your healthcare provider right away if you develop any new or worse signs or symptoms, including:
- Lung problems: new or worsening cough; shortness of breath; chest pain
- Intestinal problems: diarrhea (loose stools) or more frequent bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; severe stomach-area (abdominal) pain or tenderness
- Liver problems: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); dark urine (tea colored); bleeding or bruising more easily than normal
- Hormone gland problems: headaches that will not go away or unusual headaches; eye sensitivity to light; eye problems; rapid heart beat; increased sweating; extreme tiredness; weight gain or weight loss; feeling more hungry or thirsty than usual; urinating more often than usual; hair loss; feeling cold; constipation; your voice gets deeper; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness
- Kidney problems: decrease in your amount of urine; blood in your urine; swelling in your ankles; loss of appetite
- Skin problems: rash; itching; skin blistering or peeling; painful sores or ulcers in the mouth or nose, throat, or genital area
- Eye problems: blurry vision, double vision, or other vision problems; eye pain or redness.
Problems can also happen in other organs and tissues. These are not all of the signs and symptoms of immune system problems that can happen with OPDIVO and YERVOY. Call or see your healthcare provider right away for any new or worsening signs or symptoms, which may include:
- Chest pain; irregular heartbeat; shortness of breath; swelling of ankles;
- Confusion; sleepiness; memory problems; changes in mood or behavior; stiff neck; balance problems; tingling or numbness of the arms or legs;
- Double vision; blurry vision; sensitivity to light; eye pain; changes in eye sight;
- Persistent or severe muscle pain or weakness; muscle cramps;
- Low red blood cells; bruising
Getting medical help right away may help keep these problems from becoming more serious. Your healthcare team will check you for these problems during treatment and may treat you with corticosteroid or hormone replacement medicines. Your healthcare team may also need to delay or completely stop your treatment if you have severe side effects.
Possible side effects of OPDIVO + YERVOY
OPDIVO and OPDIVO + YERVOY can cause serious side effects, including:
- See “What is the most important information I should know about OPDIVO + YERVOY?”
- Severe infusion reactions. Tell your healthcare team right away if you get these symptoms during an infusion of OPDIVO or YERVOY: chills or shaking; itching or rash; flushing; shortness of breath or wheezing; dizziness; feel like passing out; fever; back or neck pain
- Complications, including graft-versus-host disease (GVHD), of bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with OPDIVO or YERVOY. Your healthcare provider will monitor you for these complications.
The most common side effects of OPDIVO, when used in combination with YERVOY, include: feeling tired; diarrhea; rash; itching; nausea; pain in muscles, bones, and joints; fever; cough; decreased appetite; vomiting; stomach-area (abdominal) pain; shortness of breath; upper respiratory tract infection; headache; low thyroid hormone levels (hypothyroidism); constipation; decreased weight; and dizziness. These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. You are encouraged to report side effects of prescription drugs to the FDA. Call 1-800-FDA-1088.
Before receiving OPDIVO or YERVOY, tell your healthcare provider about all of your medical conditions, including if you:
- have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus;
- have received an organ transplant; have received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic);
- have received radiation treatment to your chest area in the past and have received other medicines that are like OPDIVO;
- have a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome;
- are pregnant or plan to become pregnant. OPDIVO and YERVOY can harm your unborn baby;
- are breastfeeding or plan to breastfeed. It is not known if OPDIVO or YERVOY passes into your breast milk. Do not breastfeed during treatment with OPDIVO or YERVOY and for 5 months after the last dose of OPDIVO or YERVOY.
Females who are able to become pregnant:
Your healthcare provider should do a pregnancy test before you start receiving OPDIVO or YERVOY.
- You should use an effective method of birth control during your treatment and for 5 months after the last dose of OPDIVO or YERVOY. Talk to your healthcare provider about birth control methods that you can use during this time.
- Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with OPDIVO or YERVOY. You or your healthcare provider should contact Bristol-Myers Squibb at 1-844-593-7869 as soon as you become aware of a pregnancy.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Please see U.S. Full Prescribing Information and Medication Guide for OPDIVO and YERVOY.
© 2023 Bristol-Myers Squibb Company. OPDIVO®, and YERVOY® are registered trademarks of Bristol-Myers Squibb Company.
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