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. In 2020, Australia funded Keytruda and in 2024 /2025 the New Zealand government should be funding Opdivo and/or Keytruda. The new govenment’s policy was to fund 13 cancer drugs already funded in Australia.

At the moment, all head and neck cancer patients have to pay with insurers like Southern Cross paying  only for the oncologist. A term of treatment will cost $90,000 to $100, 000, after which the drug company will pay if needed.

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.

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.

Oncologists will suggest if patients are good candidates for Keytruda.

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

We are looking forward to having free immunotherapy for head and neck cancer.  In the meantime New Zealand and overseas researchers are looking into ways to expand the use of immunotherapy, using it first for example, before surgery and radiation. “Neo-adjuvant” therapy is showing great promise in trials.

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

Maureen Jansen