In this interview we discuss the direct-to-consumer advertising for nivolumab (Opdivo) for the treatment patients with advanced non-small-cell lung cancer.
Oncology (Williston Park). 30(6):506, 523.
Marta Batus, MD
1.There has been a lot of talk in the oncology world lately about the direct-to-consumer (DTC) advertising for nivolumab (Opdivo) for advanced squamous non–small-cell lung cancer (NSCLC). This is the first time a treatment for advanced cancer has been promoted to the mainstream public. Is this type of advertising appropriate?
Dr. Batus: It is quite impossible to avoid DTC advertising. It is easier to approach the patient (consumer) via TV ad than to convince a physician. However, most of our patients develop trusting relationships with their oncologists, and this trust will put them at ease knowing their physician will be well-informed and will recommend the most appropriate treatment. The nivolumab ad is quite powerful, feeding on emotions of a vulnerable population of patients with squamous cell lung cancer. For many years there has not been any new advancement in the treatments offered for this group of patients. The ad emphasizes a chance to live longer, which is always the goal that patients and physicians are trying to reach. I believe this ad gives a sense of hope to all who watch it; however, not everyone is a candidate for this treatment.
2. Do these DTC ads create a false sense of optimism when it comes to survival benefit, or is the data on nivolumab significant enough to warrant this type of advertising?
Dr. Batus: In fact, the nivolumab ad has been very well thought out and is accurate. Immunotherapy has revolutionized the world of oncology and increased the number of treatments offered to patients with NSCLC. Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor antibody. The clinical trials for squamous NSCLC showed a 3.2-month increase in overall survival and a 41% reduction in risk of death during treatment with nivolumab vs chemotherapy (docetaxel) in second-line treatment. The rate of response to nivolumab is 20%; 1 out of every 5 patients will respond to this treatment. Although the ad does not make a statement about long-term survival benefit, most oncologists believe that some patients treated with nivolumab will have relatively long-term survival. If you are a patient watching the nivolumab ad, you may interpret the information as more promising than it actually is. The nivolumab data for squamous and nonsquamous lung cancer were significant enough to move immunotherapy to the second line of treatment and to grant clinical trials (currently ongoing) to test immunotherapy in the first-line setting as well. However, as previously mentioned, not every patient with NSCLC is a candidate for immunotherapy.
3. As a clinician who specializes in treating patients with lung cancer, how would you address a patient who came to you wanting to try nivolumab, but it wasn’t appropriate for them for a particular reason, including cost considerations?
Dr. Batus: For patients who are not candidates for immunotherapy, such as those with autoimmune diseases or chronic infectious processes like HIV or hepatitis, I explain why they should not receive this type of treatment and the potential associated risks, including difficult-to-control symptoms from their preexisting conditions. The cost associated with the treatment has not been of significant consideration due to the patient access resources offered through the pharmaceutical companies, and the well-established financial counseling services at our medical center.
4. Do you think advanced lung cancers are being treated as aggressively as they could be? Or is it a benefit to patients to be aware of the therapies available to them so they can be their own best advocates?
Dr. Batus: I believe that the majority of academic cancer centers, where oncologists subspecialize in thoracic malignancies, have all the skills and resources needed to provide personalized, advanced care for patients with lung cancer. At Rush University Medical Center, we have well-established, weekly, multidisciplinary thoracic oncology conferences and clinics, where multiple lung cancer specialists including medical oncologists, thoracic surgeons, radiation oncologists, pulmonologists, pathologists, and radiologists review lung cancer cases and discuss the most appropriate treatment for each patient. There is a benefit for patients to be aware of the new available therapies; however, it is our (the physician’s) duty to inform and guide patients in the most beneficial treatment choices for them. Patients with lung cancer should always be offered multiple options, encouraged to participate in clinical trials if available, and asked to be involved in making decisions about treatment. Moreover, getting a second opinion at a major academic center is invaluable, as patients can be informed of the potential benefit of immunotherapy and other emerging therapies that were administered in clinical trials prior to US Food and Drug Administration approval. In my opinion, the DTC ads will increase patient awareness, but will not change or influence the choices of treatments that physicians will offer to patients with lung cancer.
Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.