The US Food and Drug Administration has approved nivolumab (Opdivo) to treat patients with advanced (metastatic) renal cell carcinoma, a form of kidney cancer, who have received a certain type of prior therapy.

“Opdivo [nivolumab] provides an important therapy option for patients with renal cell carcinoma,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research.

“It is one of few therapies that have demonstrated the ability to extend patients’ survival in treating this disease.”

Temsirolimus, approved in 2007, is the only other FDA-approved therapy that has demonstrated overall survival in renal cell cancer.

Renal cell carcinoma is the most common form of kidney cancer in adults and forms in the tissues of the kidney that make urine.

The National Cancer Institute estimates 61,560 new cases and 14,080 deaths from kidney and renal pelvis cancer in the United States this year.

“Additionally, Opdivo’s [nivolumab] extended indication, from melanoma and non-small cell lung cancer to renal cell cancer, demonstrates how immune therapies can benefit patients across a wide range of tumours,” continued Dr Pazdur.

Nivolumab works by targeting the cellular pathway known as PD-1/PD-L1 (proteins found on the body’s immune cells and some cancer cells).

By blocking this pathway, nivolumab may help the body’s immune system fight cancer cells.

Nivolumab is intended for use in renal cell carcinoma in patients who have received prior anti-angiogenic therapy (treatments that interfere with the blood vessels that contribute to the growth of cancerous cells).

The safety and efficacy of nivolumab for this use were demonstrated in an open-label, randomised study of 821 patients with advanced renal cell carcinoma whose disease worsened during or after treatment with an anti-angiogenic agent.

Patients were treated with nivolumab or another type of kidney cancer treatment called everolimus (marketed as Afinitor).

Those treated with nivolumab lived an average of 25 months after starting treatment compared to 19.6 months in those treated with everolimus.

This effect was observed regardless of the PD-L1 expression level of patients’ renal cell tumours.

Additionally, 21.5 percent of those treated with nivolumab experienced a complete or partial shrinkage of their tumours, which lasted an average of 23 months, compared to 3.9 percent of those taking Afinitor, lasting an average of 13.7 months.

The most common side effects of nivolumab for this use are conditions relating to abnormal weakness or lack of energy (asthenic conditions), cough, nausea, rash, difficulty breathing (dyspnea), diarrhoea, constipation, decreased appetite, back pain and joint pain (arthralgia).

Nivolumab also has the potential to cause serious side effects that result from the immune system effect of nivolumab (known as “immune-mediated side effects”).

These severe immune-mediated side effects involve healthy organs, including the lung, colon, liver, kidneys, hormone-producing glands and the brain. 

The FDA granted the nivolumab application a breakthrough therapy designation, fast track designation, and priority review status.

These are distinct programmes intended to facilitate and expedite the development and review of certain new drugs in light of their potential to benefit patients with serious or life-threatening conditions. 

Source: FDA