Published: 13 December 2017

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New Anti-Cancer Therapy — Immune Checkpoint Inhibitors

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Prescriber Update 38(4): 50
December 2017

Atezolizumab (Tecentriq), ipilimumab (Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda) are monoclonal antibodies. These medicines are known as immune checkpoint inhibitors because they block target proteins (‘checkpoints’) on immune cells. This action enables the immune system to boost its response against cancer cells^1,2.

There are two important immune-checkpoint receptors targeted by these medicines: cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1).

Atezolizumab, ipilimumab, nivolumab and pembrolizumab are used for the treatment of several advanced or metastatic cancers ^3-6. A range of immune-mediated adverse reactions are associated with the use of these medicines. Immune-mediated adverse reactions that are listed in the data sheets include:

• pneumonitis
• colitis
• hepatotoxicity
• nephritis and renal dysfunction
• endocrinopathies
• skin reactions
• gastrointestinal reactions
• neurological reactions
• pancreatitis
• neuropathies^3-6.

All patients taking an immune checkpoint inhibitor should be carefully monitored for signs and symptoms of immune-mediated adverse reactions^3-6. Healthcare professionals are reminded that these adverse reactions may occur weeks to months after the last dose^3-5. Further information on specific immune-mediated adverse reactions associated with each immune checkpoint inhibitor can be found in the data sheet for each medicine (www.medsafe.govt.nz/Medicines/infoSearch.asp)^3-6.

At 30 June 2017, the Centre for Adverse Reactions Monitoring (CARM) had received 41 cases reporting adverse reactions to immune checkpoint inhibitors. A review of data indicated that a range of reactions have been reported in New Zealand in association with these medicines including two reports of type 1 diabetes.

Please continue to report any adverse reactions for these medicines and any other medicine to CARM. Reports can be submitted on paper or electronically (https://nzphvc.otago.ac.nz/).

Further information on immune checkpoint inhibitors was presented to the Medicines Adverse Reactions Committee at the 171^st meeting. The report is published on the Medsafe website (www.medsafe.govt.nz/committees/MARC/Reports.asp).

References

1. American Cancer Society. 2017. Immune Checkpoint Inhibitors to Treat Cancer 23 June 2017. URL: cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/immune-checkpoint-inhibitors.html (accessed 22 November 2017).
2. National Cancer Institute. 2017. NCI Dictionary of Cancer Terms 21 July 2017. URL: cancer.gov/publications/dictionaries/cancer-terms?cdrid=772606 (accessed 22 November 2017).
3. Bristol-Myers Squibb (NZ) Limited. 2017. Opdivo Data Sheet 27 July 2017. URL: medsafe.govt.nz/profs/Datasheet/o/opdivoinf.pdf (accessed 22 November 2017).
4. Bristol-Myers Squibb (NZ) Limited. 2017. Yervoy Data Sheet 29 June 2017. URL: medsafe.govt.nz/profs/Datasheet/y/yervoyinj.pdf (accessed 22 November 2017).
5. Merck Sharp and Dohme (New Zealand) Limited. 2017. Keytruda Data Sheet 16 October 2017. URL: medsafe.govt.nz/profs/Datasheet/k/Keytruda.pdf (accessed 22 November 2017).
6. Roche Products (New Zealand) Limited. 2017. Tecentriq Data Sheet 25 August 2017. URL: medsafe.govt.nz/profs/Datasheet/t/Tecentriqinf.pdf (accessed 22 November 2017).