Written after watching the video with some extra info added. 

Immunotherapy offers new hope, but it does not work for everyone.

This is one of the main messages I gleaned from an interview with two Sydney oncologists, Dr Vanessa Chin and Dr Amy Prawira who would like to see more research to increase the benefit of immunotherapy to a wider range of patients.

Julie McCrossin, a Sydney HNC survivor, advocate and broadcaster, interviewed the two doctors as part of a World Head and Neck Cancer Day video series. The video in question was about Innovations in Chemotherapy and Immunotherapy.

When HNC is advanced and incurable, tumours can be reduced by a combination of chemotherapies. Fifty percent will experience some shrinkage, albeit with the usual chemo side effects such as hearing loss, tinnitus and these days much less nausea.

Immunotherapy has been showing promise for advanced cancers for some years now. There are two similar drugs called Opdivo and Keytruda which help the immune system recognise and attack cancer cells.

Opdivo is funded in Australia by their Pharmaceutical Benefits Scheme but not by New Zealand’s Pharmac. In Australia it is only funded for cancers in the mouth and airway and only after all other treatment options are exhausted.

A big study called Keynote 040 was released in 2019 and showed that using Keytruda as a “first line” treatment for advanced HNC, without going down the chemo combination path, resulted in longer survival.

This was good news because immunotherapy has fewer side effects and shows more promise of long-term quality of life for some. It was not accepted by the UK’s equivalent of Pharmac though, NICE, and nor have Australia and NZ started funding it. One of NZ’s HNC groups has a petition before Parliament to demand that Pharmac fund Keytruda for HNC patients.

In both Australia and NZ, outside the narrow criteria for Opdivo in Australia, patients have to pay for immunotherapy unless they can get into clinical trials.

The big dilemma is that Keytruda for example works for some, maybe 20 %, but there is no sure way of knowing who it will work for. There are ‘biomarkers” on the tumour that can indicate a better response, but these are a rough tool. I think I heard that with biomarkers there might be a 50% response which means tumour reduction or disappearance.

Keytruda and Opdivo cost $6500 for each 3-weekly dose. The doctors tell patients the minimum they need to pay to see if it is going to work and the maximum (in NZ the drug company provides Keytruda free once a certain amount is reached). They don’t advise mortgaging  the house or getting into serious debt.

Here are some NZ options on funding it from the drug company involved. https://www.fightcancer.co.nz/about-keytruda/keytruda-access.xhtml

This is a difficult field. Like finding a vaccine for Covid, improved immunotherapy looms as a possible solution to a serious health problem.

One day, researchers will find a way of using these powerful immunotherapy drugs for the benefit of most patients not a few.

Maureen Jansen